Deaths from heart failure
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Deaths from Heart Failure: An Overview
Heart Failure Mortality Trends
Heart failure (HF) remains a significant public health issue globally, contributing to high mortality rates despite advancements in treatment and management. In the United States, heart failure-related deaths have been extensively studied, revealing trends from 2000 to 2014 that highlight the persistent burden of this condition across various demographics. Similarly, in Scotland, a retrospective analysis from 1979 to 1992 showed that heart failure was often underreported as the underlying cause of death, despite its significant contribution to overall mortality and coronary heart disease mortality.
Modes of Death in Heart Failure
Sudden Death vs. Progressive Heart Failure
The modes of death in heart failure patients are diverse and complex. Sudden death, often attributed to arrhythmias, and progressive pump failure are the two primary modes of death. Studies indicate that sudden death accounts for a substantial proportion of heart failure-related deaths, although the exact mechanisms remain unclear . The Seattle Heart Failure Model (SHFM) has been instrumental in predicting the mode of death, showing that higher SHFM scores correlate with increased risks of both sudden death and pump-failure death.
Heart Failure with Preserved Ejection Fraction (HFpEF)
Patients with heart failure with preserved ejection fraction (HFpEF) exhibit different mortality patterns compared to those with reduced ejection fraction (HFrEF). Noncardiovascular causes are a significant contributor to mortality in HFpEF patients, with sudden death accounting for approximately 25% to 30% of deaths in clinical trials. This highlights the need for standardized definitions and reporting of death modes in HFpEF to better understand and address the underlying causes.
Factors Influencing Mortality
Demographic and Clinical Factors
Several demographic and clinical factors influence mortality in heart failure patients. Advanced age, male sex, diabetes, smoking, and kidney disease are associated with higher risks of both all-cause and cardiovascular deaths. Additionally, health-related quality of life (HRQL) is a strong predictor of mortality, with lower HRQL scores correlating with higher risks of death and hospitalization across different regions and patient subgroups.
Impact of Ejection Fraction
The ejection fraction (EF) plays a crucial role in determining the cause of death in heart failure patients. Those with preserved EF are more likely to die from noncardiovascular causes, whereas those with reduced EF have a higher likelihood of dying from coronary heart disease. Over time, the proportion of cardiovascular deaths has decreased among patients with preserved EF, reflecting improvements in managing cardiovascular risk factors.
Conclusion
Heart failure continues to be a leading cause of death worldwide, with diverse modes of death influenced by various demographic and clinical factors. Understanding these patterns is crucial for developing targeted strategies to reduce mortality. Standardized classification systems and predictive models like the SHFM can aid in identifying high-risk patients and tailoring interventions to improve outcomes. As the global population ages, addressing the multifaceted challenges of heart failure will remain a critical priority in healthcare.
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