Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals

Nathalie Conrad, Andrew Judge, Jenny Tran, et al

Lancet 2018; 391: 572-580

Summary

Background 背景

Large-scale and contemporary population-based studies of heart failure incidence are needed to inform resource planning and research prioritisation but current evidence is scarce. We aimed to assess temporal trends in incidence and prevalence of heart failure in a large general population cohort from the UK, between 2002 and 2014.

我们需要有关心功能衰竭的基于人口的大规模研究结果，以便合理调整医疗资源及研究方向，但是，尚缺乏相关证据。我们试图评估2002年至2014年间英国一个大的人群队列中心功能衰竭发病率的时间趋势。

Methods 方法

For this population-based study, we used linked primary and secondary electronic health records of 4 million individuals from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex. Eligible patients were aged 16 years and older, had contributed data between Jan 1, 2002, and Dec 31, 2014, had an acceptable record according to CPRD quality control, were approved for CPRD and Hospital Episodes Statistics linkage, and were registered with their general practice for at least 12 months. For patients with incident heart failure, we extracted the most recent measurement of baseline characteristics (within 2 years of diagnosis) from electronic health records, as well as information about comorbidities, socioeconomic status, ethnicity, and region. We calculated standardised rates by applying direct age and sex standardisation to the 2013 European Standard Population, and we inferred crude rates by applying year-specific, age-specific, and sex-specific incidence to UK census mid-year population estimates. We assumed no heart failure for patients aged 15 years or younger and report total incidence and prevalence for all ages (>0 years).

在此项基于人口的研究中，我们将临床实践研究数据链接(CPRD)中4百万人的主要和次要电子病例系统相链接。CPRD是年龄与性别分布具有代表性的英国人群队列。入选标准包括年龄16岁以上，2002年1月1日至2014年12月31日间有相关资料，病历记录质量符合CPRD质量控制要求，得到CPRD和医院事件统计数据库批准，且在自己的全科医生处登记至少12个月。对于心功能衰竭病例，我们从电子病历记录系统中收集了有关基线特征的最新资料（诊断2年内），以及有关合并症、社会经济状况、种族及地区等信息。我们根据2013年欧洲标准人口统计结果，采用年龄和性别直接标准化方法计算标化率，我们根据英国年中人口统计结果，采用年份、年龄和性别特异性发病率估计粗发病率。我们假设年龄15岁以下患者没有心功能衰竭病例，并据此报告所有年龄组的总发病率及罹患率。

Findings 结果

From 2002 to 2014, heart failure incidence (standardised by age and sex) decreased, similarly for men and women, by 7% (from 358 to 332 per 100 000 person-years; adjusted incidence ratio 0·93, 95% CI 0·91–0·94). However, the estimated absolute number of individuals with newly diagnosed heart failure in the UK increased by 12% (from 170 727 in 2002 to 190 798 in 2014), largely due to an increase in population size and age. The estimated absolute number of prevalent heart failure cases in the UK increased even more, by 23% (from 750 127 to 920 616). Over the study period, patient age and multi-morbidity at first presentation of heart failure increased (mean age 76·5 years [SD 12·0] to 77·0 years [12·9], adjusted difference 0·79 years, 95% CI 0·37–1·20; mean number of comorbidities 3·4 [SD 1·9] vs 5·4 [2·5]; adjusted difference 2·0, 95% CI 1·9–2·1). Socioeconomically deprived individuals were more likely to develop heart failure than were affluent individuals (incidence rate ratio 1·61, 95% CI 1·58–1·64), and did so earlier in life than those from the most affluent group (adjusted difference −3·51 years, 95% CI −3·77 to −3·25). From 2002 to 2014, the socioeconomic gradient in age at first presentation with heart failure widened. Socioeconomically deprived individuals also had more comorbidities, despite their younger age.

从2002年至2014年，心衰发病率（根据年龄和性别标化）逐年降低，男性与女性相似，共下降7%（从每100 000人年 358 例下降到 332 例；校正发病率比值 0·93, 95% CI 0·91–0·94）。然而，由于人口及年龄增加，英国新诊断的心衰患者人数增加12%（从2002年的170 727例到2014年的190 798例）。估计英国心功能衰竭患病人数增加更为明显，达23%（从750 127例增加到920 616例）。在研究期间，首次发生心功能衰竭时，患者的年龄及多种合并症增加（平均年龄 76·5 岁 [SD 12·0] 增加到 77·0 岁 [12·9]，校正后差异 0·79 岁，95% CI 0·37–1·20；平均合并症数目 3·4 [SD 1·9] vs 5·4 [2·5]，校正后差异 2·0, 95% CI 1·9–2·1）。社会经济状况较差的人群更容易发生心功能衰竭（发病率比值1·61, 95% CI 1·58–1·64），并且发病年龄更早（校正后差异−3·51 岁，95% CI −3·77 to −3·25）。从2002年至2014年，首次发病年龄的社会经济状况差异在增大。尽管发病年龄较轻，但社会经济状况较差人群有更多的合并症。

Interpretation 结论

Despite a moderate decline in standardised incidence of heart failure, the burden of heart failure in the UK is increasing, and is now similar to the four most common causes of cancer combined. The observed socioeconomic disparities in disease incidence and age at onset within the same nation point to a potentially preventable nature of heart failure that still needs to be tackled.

尽管标化发病率呈中度降低趋势，但英国心功能衰竭的疾病负担在增加，目前已经相当于4种最常见肿瘤的总和。在同一国家内，我们观察到发病率及发病年龄的社会经济分布差异，提示需要对于心功能衰竭的可预防因素进行研究。