More Living With Heart Failure

Survival up, incidence down for women, since 1950

WEDNESDAY, Oct. 30, 2002 (HealthDayNews) -- Americans are apparently now living longer with heart failure, mostly because of improvements in treatment for the incurable disease.

Researchers tracked the trends in heart failure over the past 50 years and found the ailment is now as much as 40 percent less common in women than it was in 1950. However, it remained unchanged in men over the period, possibly reflecting advancements in treating heart attacks, the chief source of heart failure in men.

At the same time, the chances of surviving the disease are now about a third better than they were five decades ago, according to the study, which appears in tomorrow's issue of The New England Journal of Medicine.

"We are now seeing evidence that survival following onset is improving," says Dr. Daniel Levy, director of the Framingham Heart Study and a researcher with the National Heart, Lung, and Blood Institute. The lack of a decline in cases among men isn't a failure, Levy adds. "Improvements in management of myocardial infarction have resulted in the survival of more people with the condition."

Even so, other experts say heart failure remains epidemic in this country, affecting some 4.8 million people and killing nearly 290,000 a year. There is no cure for the disease short of a transplant, although even this procedure doesn't restore a normal lifespan to organ recipients.

Two classes of drugs, angiotensin-converting enzyme (ACE) inhibitors and beta blockers, can ease the strain on failing hearts. These have made a major impact in short-term survival rates. However, the long-range outlook for patients remains bleak, and more than half die within five years of being diagnosed with the condition.

"Medical therapies are now improving survival. But there's no indication that the epidemic is going to stop," says Dr. Margaret Redfield, a heart failure expert at the Mayo Clinic and author of an editorial accompanying the journal article.

Surges in obesity and diabetes, two major risk factors for heart failure, could hurt the gains made in decades past, she says. And as more people receive beta blockers and ACE inhibitors, which are widely under-prescribed, the number of people living with heart failure will increase. High blood pressure is another important risk factor for the disease.

The Framingham study is an ongoing look at thousands of Massachusetts residents and their children who entered the project in 1948. It recently added a third generation of volunteers, who now total about 14,000.

Levy and his colleagues compared heart failure rates and mortality in 10,317 men and women. Between 1950 and 1999, 1,075 members of the group, or about 10 percent, developed heart failure, 51 percent of whom were female.

The incidence of the disease was steady among men in the study, but fell by between 31 percent and 40 percent among women. At the same time, the one-month, one-year and five-year mortality rates fell between 1950 and 1999, to 11 percent, 28 percent and 59 percent among men, and 10 percent, 24 percent and 48 percent among women.

Dr. Clyde Yancy, an internist at the University of Texas Southwestern Medical Center and a spokesman for the American Heart Association, says the latest results are encouraging.

"What is really exciting is that the data still don't reflect current practice, and my suspicion is that in everyday practice it's even better" now than in 1999, Yancy says.

Yancy warns, however, that "we can't assume that we've won anything. It's very clear to everybody involved that there is no cure" for heart failure.

What To Do

For more on heart failure, try the American Heart Association or the Heart Failure Society of America.

SOURCES: Daniel Levy, M.D., director, Framingham Heart Study, National Heart, Lung, and Blood Institute; Margaret Redfield, M.D., director, heart failure clinic, Mayo Clinic, Rochester, Minn.; Clyde Yancy, M.D., associate professor, internal medicine, University of Texas Southwestern Medical Center, Dallas; Oct. 31, 2002, The New England Journal of Medicine
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