CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Jing Fang, MD*,
Nora L. Keenan, PhD,
George A. Mensah, MD and
Janet B. Croft, PhD
* Centers for Disease Control and Prevention, 4770 Bulford Hwy, NE, MS K-47, Atlanta, Georgia 30341-3717 (Email: jfang{at}cdc.gov).
We would like to thank Dr. Sorrell and colleagues for their interest in our work (1). The primary objective of our study was to use national surveillance data to examine annual hospitalization rates and trends in characteristics for patients hospitalized with heart failure as either the first-listed diagnosis or additional (second to seventh) diagnosis, as well as to assess the trends in other clinical conditions that lead to hospitalization among patients with any mention of heart failure. Thus, we did not present data on left ventricular ejection fraction or speculate on the impact of systolic or diastolic ventricular function in our conclusions. In fact, the National Hospital Discharge Survey contains no information for any measurement of left ventricular function.
We agree with Dr. Sorrell and colleagues that a substantial proportion of patients have heart failure with preserved systolic function and that this proportion has increased over time (2). We would like to use International Classification of Diseases–Ninth Revision–Clinical Modification (ICD-9-CM) codes to identify heart failure with systolic heart failure (ICD-9-CM 428.2) and diastolic heart failure (ICD-9-CM 428.3). Unfortunately, these codes were not in effect until 2003. Previously, both conditions were coded as 428.0. The data showed that the percentages of recorded isolated systolic heart failure were 1.2%, 1.7%, and 1.8% for 2003, 2004, and 2005, respectively, and the corresponding percentages for isolated diastolic heart failure were 3.0%, 4.3%, and 4.5%, respectively. Although the percentages for diastolic heart failure were more than twice those of systolic heart failure, neither contributed a significant proportion to total heart failure. However, as pointed out by Dr. Sorrell and colleagues, women had a higher proportion of isolated diastolic heart failure than men (4.7% vs. 3.0%, p < 0.001) and had a lower proportion of isolated systolic heart failure (1.2% vs. 2.0%, p < 0.001). Because only 3 years of hospitalization data are available for identifying systolic heart failure and diastolic heart failure separately, we are unable to present 25-year trends.
Therefore, with the limitations of the National Hospital Discharge Survey, we are unable to conclude that the increase in the prevalence of diastolic heart failure contributed to the finding of increasing heart failure hospitalization over the past 25 years.
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References
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1. Fang J, Mensah GA, Croft JB, Keenan NL. Heart failure-related hospitalization in the U.S., 1979–2004 J Am Coll Cardiol 2008;52:428-434.[Abstract/Free Full Text]2. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction N Engl J Med 2006;355:251-259.[Abstract/Free Full Text]
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Impact of Diastolic Dysfunction on Heart Failure-Related Hospitalizations
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J. Am. Coll. Cardiol. 2009 53: 457.
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