Precious time

Over 5 million people in North America are affected. Heart failure is the leading cause of hospitalization and for the first time, physicians can now answer the question most patients want to know—“How long do I have doctor?”

Published in the February issue of American Heart Journal, the Institute for Clinical Evaluative Sciences (ICES) study identified Ontario patients between 1999 – 2001, who were newly hospitalized and diagnosed with heart failure. Scientists followed these patients over a six year period to determine overall prognosis and various high/low risk patients based on hospital admission characteristics such as: age, blood pressure, blood tests, prior medical history of stroke, cancer and dementia. Lead author and ICES scientist, Dr. Dennis Ko says, “Heart failure is a very serious condition with a high recurrence and mortality rate in the elderly with survival worse than many aggressive cancers. Physicians and patients had little understanding of prognosis after hospitalization, this information is crucial to identify patients who may not be suitable for invasive treatment. There is now an opportunity to begin the engagement of discussion in adapting a medical plan and exploring an individual’s preference. For the first time, we have a better picture of expected survival in this category of patients and who may benefit for palliative or end of life care.”

The ICES results: 

• The study sample was restricted to patients who were residents of Ontario between 20 and 105 years of age
• The average age of heart failure patient was 75.8 years; 50% were female
• Scientists studied 9,943 patients who were newly hospitalized with heart failure over a 2 year period, with a median follow up of 6 years
• The average survival among hospitalized heart failure patients was 2.4 years or 29 months
• Survival varied substantially across risk groups: average survival was 8 months for patients in high risk group; 3 months in very high risk group
• Hospitalized heart failure patients had a 1 year mortality of 33.1% and a 5-year mortality of 68.7%

“An important aspect of heart failure care has not been adequately addressed”, says Dr. Ko. “An end of life conversation does not take place, mainly because it’s difficult for physicians to know which patient has limited survival. With detailed life expectancy data, we believe our results may assist in making more informed and difficult treatment decisions focusing on improving the quality of life among these patients with a few months to live.”

“Heart failure" means that your heart isn't pumping blood as well as it should. Heart failure doesn't mean your heart has stopped working or that you are having a heart attack (but, people with heart failure often have had a heart attack in the past). Heart failure occurs when the heart is unable to pump sufficient blood to meet the body's demand. It is not a single disease entity, but rather the end result of a variety of cardiovascular problems. When heart tissue is damaged and the function of the heart is compromised, the body initiates compensatory responses such as increased heart rate and thickening of the heart's muscular wall. The five most common causes of heart failure are coronary artery disease (due to atherosclerosis), valvular heart disease, high blood pressure, alcohol, and a disease of heart muscle known as dilated cardiomyopathy. Each of these five conditions can cause heart failure by damaging heart muscle and therefore increasing the workload on the remainder of the heart.

The study “Life expectancy after an index hospitalization for heart failure patients: a population based study” is in the February issue of American Heart Journal.

Author affiliations:ICES (Drs. Ko, Alter, You, Tu) Mr. Austin, Qiu, Ms. Stukel); Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (Drs. Ko, Tu); Division of Cardiology and the Li Ka Shing Knowledge Institute of St. Michael’s Hospital (Dr.Alter); Division of Cardiology, University Health Network (Dr.Lee); Center for the Evaluative Clinical Sciences, Dartmouth Medical School, NH; (Ms.Stukel); Division of General Internal Medicine, Sunnybrook Health Sciences Centre (Dr.Tu); Toronto, Ontario.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

FOR MORE INFORMATION, PLEASE CONTACT:

• Kristine Galka
• Media Advisor, ICES
• 416.480.4780 or 416.629.8493
• [email protected]