Prognosis following a diagnosis of heart failure and the role of primary care: a review of the literature

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Figure 1. Changes in age-standardised prescribing rates between 1996 & 2003. ¹⁵ ACE = angiotensin converting enzyme.

Table 1. Survival rates in chronic heart failure

Study	Setting	Total participants	Participants with HF	Country	Average age at outset, years	1-year survival, %	2-year survival, %	5-year survival, %	10-year survival, %
Mosterd et al 2001 ⁵	Participants from Rotterdam population study screened for diagnosis or symptoms of HF	5255	181	The Nether-lands	68.9	89	79	59	–
Nielsen et al 2003 ⁶	Cross-sectional sample from three general practices, screened for participants with diagnosis or symptoms of HF	2157 including control group (571) and heart disease but no HF (218)	67 with community managed HF: 33 in hospital managed HF comparator	Denmark	74.1	–	–	61	–
Hobbs et al 2007 ⁷	Participants from UK general practice screened for HF	6162 including 1062 at high risk for HF and 982 on diuretics at baseline	Previous clinical label of HF ( 782)	UK	64.2	–	–	63	–
Tsutsui et al 2007 ⁸	Data from The Cardiac Registry of Heart Failure in General Practice	2685	1280 followed-up in hospital and 1405 by GP	Japan	74	90.9	–	–	–
Pons et al 2010 ⁹	Consecutive sample from outpatient HF clinic	960	All followed-up in outpatient cardiology clinic	Spain	69	89.4	–	–	–
Taylor et al 2012 ¹⁰	As per Hobbs et al 2007 paper: ⁷ 10-year follow-up of ECHOES cohort	See above	See above	UK	64.2	–	–	–	26.7
Taylor et al 2017 ¹¹	Survival analysis using UK primary care records from The Health Improvement Network	54 313	All with first diagnosis of HF	UK	76.5	81.3	–	51.5	29.5

ECHOES = Echocardiographic Heart of England Screening (ECHOES). HF = heart failure.

Table 2. Survival rates in acute heart failure

Study	Participants	Total participants	Country	Average age, years	30 day survival, %	1-year survival, %	3-year survival, %	5-year survival, %	6-year survival, %
Blackledge et al 2003 ¹²	Following admission to hospital with first episode of HF	12 220	UK	76.8	79.1	57.1	38.9	27	23.2
Nielsen et al 2003 ⁶	Cross-sectional sample from three general practices, screened for participants with diagnosis or symptoms of HF	2157: 33 in hospital HF group; 67 in GP-managed HF; control group (571) and heart disease but no HF (218)	Denmark	74.1	–	–	–	39	–
Goldberg et al 2007 ¹³	Recruited from 11 sites following admission with acute HF	2445	US	76	–	62.7	–	21.5	–
Ko et al 2008 ¹⁴	Recruited following first admission with HF	9943	Canada	75.8	–	66.9	–	31.3	–
Jhund et al 2009 ¹⁵	Every admission with first episode of HF in Scotland during study period	116 556	Scotland	70.7	80.8	55.8	–	26	–
Parenica et al 2013 ¹⁶	Recruited from seven sites following admission with acute HF	4153	Czech Republic	72.8	82.8	79.7	64.5	–	–

Box 1. European Society of Cardiology heart failure categories by ejection fraction ³

Category of heart failure	Abbreviation	Left ventricular ejection fraction, %	Additional criteria to meet diagnosis
Heart failure with reduced ejection fraction	HFrEF	<40	Not required
Heart failure with mid-range ejection fraction	HFmrEF	40–49	Elevated levels of natriuretic peptides and either relevant structural heart disease or diastolic dysfunction
Heart failure with preserved ejection fraction	HFpEF	≥50	Elevated levels of natriuretic peptides and either relevant structural heart disease or diastolic dysfunction

Box 2. New York Heart Association classification

NYHA Class	Definition
I	No limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnoea
II	Slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness, or angina pectoris
III	Marked limitation of physical activity. Although patients are comfortable at rest, less than ordinary activity will lead to symptoms
IV	Inability to carry out any physical activity without discomfort. Symptoms of congestive cardiac failure are present even at rest. Increased discomfort with any physical activity