NEW YORK, Jan 11 (Reuters Health) -- Despite advances in the diagnosis and treatment of heart disease, congestive heart failure -- inability of the heart to pump sufficient blood to other organs -- is still a serious problem in the United States, a study suggests.
Dr. Michele Senni and colleagues, of the Mayo Clinic and Mayo Foundation in Rochester, Minnesota, report in the January 11th issue of Archives of Internal Medicine that the incidence of heart failure and associated survival rates did not improve in their city between 1981 and 1991.
After reviewing data compiled by hospitals and nursing homes in Rochester, Senni's team identified 107 patients who were newly diagnosed with congestive heart failure in 1981 and 141 who were diagnosed in 1991.
The incidence of heart failure remained essentially unchanged in Rochester during the study period, the team determined. After the investigators accounted for age and sex differences between the two patient groups, they calculated that there were 2.8 cases of heart failure per 1,000 person-years in 1981 and 3.0 cases per 1,000 person-years in 1991.
Similarly, prognosis was no better for the 1991 group than for the 1981 group. "Despite the use of ACE inhibitors in more than 40% of patients in the 1991 cohort period, we did not observe changes in survival rates," the team reports. ACE inhibitors are a class of drugs used to control blood pressure and prevent heart failure.
"The well-recognized shift in the age distribution of our population and the higher incidence of (heart failure) in the elderly engender alarm concerning the economic burden of this syndrome," Senni's group emphasizes.
The team concludes that more aggressive treatment of heart failure is needed "to realize the beneficial effects of (drugs) on survival of patients with (heart failure) in the community."
In an editorial in the same issue of the journal, two experts term heart failure an "ongoing epidemic."
"The study of (heart failure) from a community-wide perspective is woefully inadequate," according to Dr. Robert J. Goldberg, of the University of Massachusetts in Worcester, and Dr. Marvin A. Konstam, of Boston, Massachusetts.
The editorialists call for long-term studies of heart failure and the establishment of community databases. They point out that these research tactics have been useful in guiding the treatment of heart attacks.
SOURCE: Archives of Internal Medicine 1999;159:15-17, 29-34.
