Mortality from heart failure in an English population, 1979-2003: study of death certification

Objective: It is widely held that there will be an epidemic of heart failure in Europe and North America as a result of increased survival from myocardial infarction and other coronary heart disease. The study objective was to discover if the decline in mortality from coronary heart disease has been accompanied by a rise in mortality from heart failure in the study population. Design: Analysis of database of mortality records including all certified causes of death, not just the underlying cause, from 1979 - 2003. Setting: Former Oxford NHS Region, England. Patients: Data from death certificates of all who died in the population covered. Main results: Mortality rates for heart failure fell at very similar rates as those from coronary heart disease. In men, the average annual fall in mortality from coronary heart disease was 22.7% (95% confidence intervals 22.8 to 22.5) and that from heart failure was 22.9% (23.2 to 22.5). In women, the average annual fall in mortality from coronary heart disease was 22.3% (22.6 to 22.1) and that from heart failure was 22.6% (23.0 to 22.3). Conclusions: The decline in mortality from coronary heart disease has not been accompanied by a rise in mortality from heart failure. A future epidemic of heart failure, as a consequence of the decline in mortality from coronary heart disease, seems unlikely.