title: Trends in long-term cardiovascular mortality and morbidity in men and women with heart failure of ischemic versus non-ischemic aetiology in Western Australia between 1990 and 2005.
abstract: BACKGROUND
  It is uncertain if improvements in long-term cardiovascular (CV) mortality have occurred in both men and women with ischemic and non-ischemic forms of heart failure (HF).
  
  
  METHODS
  The Western Australia Hospital Morbidity Database was used to identify all index (first-ever) hospitalizations for HF between 1990 and 2005. Patients were followed until death attributed to cardiovascular causes or censored on December 31, 2006 to determine 5-year survival. Cox proportional hazards models were used to compare the adjusted mortality hazard ratio (HR) during the study follow-up (4-year periods).
  
  
  RESULTS
  A total of 21,507 patients (mean age 73.9 years, 49.1% women) were identified. Women were significantly older than men, and less likely to have ischemic HF (38.8% versus 46.1%). Over the period, age-standardized incidence of first HF hospitalization declined but with the least decline in women with non-ischemic HF (-13.3%) compared to other subgroups. Risk-adjusted 5-year CV mortality declined over the study period, with HR 0.64 (95% CI 0.60-0.68) for patients admitted in 1998-2001 compared to 1990-1993, with significant improvement in both forms of HF, and in both sexes and across age groups. However, overall total HF hospitalizations increased (+26.7%) over the period, particularly for non-ischemic HF (+43.7%), of which elderly women formed the predominant group.
  
  
  CONCLUSIONS
  Risk-adjusted long-term survival improved similarly in men and women, including the elderly, with ischemic and non-ischemic forms of HF during 1990-2005 in Western Australia. However, there was a growing burden of HF hospitalizations particularly for HF of non-ischemic aetiology.
authors.affiliation: School of Population Health (M431), University of Western Australia, Perth, Western Australia, Australia. kteng@meddent.uwa.edu.au
authors.forename: Tiew-Hwa Katherine
authors.initials: TH
authors.lastname: Teng
authors.forename: Joseph
authors.initials: J
authors.lastname: Hung
authors.forename: Matthew
authors.initials: M
authors.lastname: Knuiman
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.forename: Leonard
authors.initials: L
authors.lastname: Arnolda
authors.forename: Ian
authors.initials: I
authors.lastname: Jacobs
authors.forename: Michael
authors.initials: M
authors.lastname: Hobbs
authors.forename: Frank
authors.initials: F
authors.lastname: Sanfilippo
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.forename: Judith
authors.initials: J
authors.lastname: Finn
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D017678:Sex Distribution; D014904:Western Australia / Q000453:epidemiology