More 'malignant' than cancer? Five-year survival following a first admission for heart failure

Background: The prognostic impact of heart failure relative to that of 'high-profile' disease states such as cancer, within the whole population, is unknown. Methods: All patients with a first admission to any Scottish hospital in 1991 for heart failure, myocardial infarction or the four most common types of cancer specific to men and women were identified. Five-year survival rates and associated loss of expected life-years were then compared. Results: In 1991, 16 224 men had an initial hospitalisation for heart failure (n = 3241), myocardial infarction (n = 6932) or cancer of the lung, large bowel, prostate or bladder (n = 6051). Similarly, 14 842 women were admitted for heart failure (n = 3606), myocardial infarction (n = 4916), or cancer of the breast, lung, large bowel or ovary (n = 6320). With the exception of lung cancer, heart failure was associated with the poorest 5-year survival rate (approximately 25% for both sexes). On an adjusted basis, heart failure was associated with worse long-term survival than bowel cancer in men (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97; P < 0.01) and breast cancer in women (odds ratio, 0.59; 95% CI, 0.55-0.64; P < 0.001). The overall population rate of expected life-years lost due to heart failure in men was 6.7 years/1000 and for women 5.1 years/1000. Conclusion: With the notable exception of lung cancer, heart failure is as 'malignant' as many common types of cancer and is associated with a comparable number of expected life-years lost. (C) 2001 European Society of Cardiology. All rights reserved.