Trends in standardized mortality in men and women with heart failure: a nationwide analysis of 700,000 individuals over two decades
D Lindholm, J SundstromAbstract
Background
There have been reports of improving heart failure (HF) prognosis over time. These estimates, however, seldom take secular changes in life expectancy in the underlying population into account, which may yield biased results.
Purpose
To assess trends in age- and sex-specific standardized mortality ratios (SMR), i.e. fold excess mortality vs. general population, in men and women with HF.
Methods
We used Swedish nationwide healthcare register data 2002-2023, and data from the Human Mortality Database. Mortality rates were estimated using Poisson regression on time-split data, employing generalized additive models, with age, sex, and period entered as a tensor product smooth. SMRs were estimated similarly but using the expected general population age-, sex-, and period-specific mortality as the denominator.
Results
We identified 711,941 HF patients, 48% women. The SMRs decreased only in the early part of the observation period. For the last decade, the excess mortality in HF patients compared with the general population tended to be virtually unchanged. Furthermore, irrespective of period, women experienced a consistently higher excess mortality with HF than men.
Conclusions
Compared with the general population, patients with HF experienced substantial excess mortality that tended to not change much during the last decade. There are persistent sex differences in prognosis, with women experiencing higher standardized mortality.Fold excess mortalityFor image description, please refer to the figure legend and surrounding text.