title: Improved survival after heart failure: a community-based perspective.
abstract: BACKGROUND
  Heart failure is a highly prevalent, morbid, and costly disease with a poor long-term prognosis. Evidence-based therapies utilized over the past 2 decades hold the promise of improved outcomes, yet few contemporary studies have examined survival trends in patients with acute heart failure. The primary objective of this population-based study was to describe trends in short- and long-term survival in patients hospitalized with acute decompensated heart failure (ADHF). A secondary objective was to examine patient characteristics associated with decreased long-term survival.
  
  
  RESULTS
  We reviewed the medical records of 9748 patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 1995, 2000, 2002, and 2004. Patients hospitalized with ADHF were more likely to be elderly and to have been diagnosed with multiple comorbidities in 2004 compared with 1995. Over this period, survival was significantly improved in-hospital, and at 1, 2, and 5 years postdischarge. Five-year survival rates increased from 20% in 1995 to 29% in 2004. Although survival improved substantially over time, older patients and patients with chronic kidney disease, chronic obstructive pulmonary disease, anemia, low body mass index, and low blood pressures had consistently lower postdischarge survival rates than patients without these comorbidities.
  
  
  CONCLUSIONS
  Between 1995 and 2004, patients hospitalized with ADHF have become older and increasingly comorbid. Although there has been a significant improvement in survival among these patients, their long-term prognosis remains poor, as fewer than 1 in 3 patients hospitalized with ADHF in 2004 survived more than 5 years.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Joffe
authors.forename: Kristy
authors.initials: K
authors.lastname: Webster
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kiernan
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Chad
authors.initials: C
authors.lastname: Darling
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011379:Prognosis; D012111:Residence Characteristics; D015996:Survival Rate; D013997:Time Factors
keywords: acute heart failure; population surveillance; survival; time trends