20-year trends in cause-specific heart failure outcomes by sex, socioeconomic status, and place of diagnosis: a population-based study

Background: Heart failure (HF) is a global pandemic but contemporary trends in cause-specific outcomes among different population groups are unknown. Methods: In a retrospective cohort of incident HF patients between 1998 and 2017 (N=88,416, mean age 78-years, 49% female, median follow-up 2.4 years), cause-specific hospitalisation and mortality were investigated. Findings: First-year age-adjusted hospitalisation rate increases were: all-cause 28% from 97.1 (95% CI 94.3,99.9) to 124.2 (120.9,127.5); HF-specific 28% from 17·2 (16·2,18·2) to 22·1 (20·9,23·2) and non-cardiovascular 42% from 59·2 (57·2,61·2) to 83·9 (81·3,86·5) per 100 person-years. Over 70% of all admissions were for non-cardiovascular causes and annual rate increases were faster for women (+3·9%; 2·8,4·9) than men (+1·4%; 0·6,2·1) (P<0·0001) and for HF patients diagnosed in hospital (+2.4%; 1·4,3.3) than in the community (+1·2%; 0·3,2·2). Annual increases for HF hospitalisations were 2·6% (1·9,3·4) for women and 1·6% (0·6,2·6) for the most deprived, compared to stable rates in men and the most affluent. Overall, the most deprived (adjusted Incident Rate Ratio 1·20; 1·17,1·24) and hospital-diagnosed groups (aIRR 1·52; 1·49,1·55) had significantly higher risk of all-cause admission, but women had significantly lower risk than men (aIRR 0·91; 0·90,0·92). All-cause first-year age-adjusted mortality rate reduction was 6% from 24·5 (23·4,39·2) to 23·0 (22·0,24·1). Annual rate reductions were -1·4% (-2·3, -0·5) in men but stable for women and -2·7% (-3·2, -2·2) for the community group compared to -1·1% (-1·8, -0·4) in the hospital-diagnosed group (p