CLINICAL STUDY
Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study
Peter A. McCullough, MD, MPH, FACC, FACP*,*,
Edward F. Philbin, MD, FACC ,
John A. Spertus, MD, MPH, FACC ,
Scott Kaatz, DO, FACP ,
Keisha R. Sandberg, BS|| and
W. Douglas Weaver, MD, FACC||
* Departments of Basic Science and Internal Medicine, Cardiology Section, University of Missouri-Kansas City School of Medicine, Truman Medical Center, Kansas City, Missouri, USA
Albany Medical College, Albany, New York, USA
University of Missouri-Kansas City School of Medicine, Mid-America Heart Institute, Kansas City, Missouri, USA
Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
|| Henry Ford Heart and Vascular Institute, Detroit, Michigan, USA
Manuscript received December 8, 2000;
revised manuscript received September 17, 2001,
accepted September 20, 2001.
* Reprint requests and correspondence: Dr. Peter A. McCullough, Department of Internal Medicine, Cardiology Section, University of Missouri-Kansas City School of Medicine, Truman Medical Center, 2301 Holmes Street, Kansas City, Missouri 64108, USA.
mcculloughp{at}umkc.edu
OBJECTIVES: The purpose of this study was to create an automated surveillance tool for reporting the incidence, prevalence and processes of care for patients with heart failure.
BACKGROUND: Previous epidemiologic studies suggest that the increasing prevalence of heart failure is a consequence of improved survival coupled with minimal changes in disease prevention. Developing new, efficient methods of assessing the incidence and prevalence of heart failure could allow continued surveillance of these rates during an era of rapidly changing treatments and health care delivery patterns.
METHODS: Using administrative data sets, we created a definition of heart failure using diagnosis codes. After adjustment for patients leaving our health system or death, we derived the incidence, prevalence and mortality of the population with heart failure from 1989 to 1999.
RESULTS: A total of 29,686 patients of all ages, 52.6% women and 47.4% men, met the definition of heart failure. Mean ages were 71.1 ± 14.5 for women and 67.7 ± 14.4 for men, p < 0.0001. Race proportions were 50.5% white, 44.6% African American and 4.9% other race. Incidence rates were higher in men and African Americans across all age groups. There was an annual increase in prevalence of 1/1,000 for women and 0.9/1,000 for men, p = 0.001 for both trends.
CONCLUSIONS: Through the feasible and valid use of automated data, we have confirmed a chronic disease epidemic of heart failure manifested primarily by an increase in prevalence over the past decade. Our surveillance system mirrors the results of epidemiologic studies and may be a valid method for monitoring the impact of prevention and treatment programs.
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Abbreviations and Acronyms
| | CHF | | congestive heart failure | | DRG | | diagnosis related group | | HAP | | Health Alliance Plan | | HFHS | | Henry Ford Health System | | ICD-9-CM | | 9th International Classification of Diseases, Clinical Modification | | MCO | | managed care organization | | NHANES | | National Health And Nutrition Examination Survey | | NYHA | | New York Heart Association | | REACH | | Resource Utilization Among Congestive Heart Failure study |
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