Secular trends of heart failure among US male physicians

Background Heart failure (HF) remains a major public health issue. Data on long-term trends in the incidence of HF and survival after its onset are limited. Methods A prospective cohort study conducted between 1985 and 2004 in 21 906 participants of the Physiciansʹ Health Study I who were alive and free of HF on January 1, 1985. Results After an average follow-up of 16.8 years, a total of 909 incident cases of HF occurred in this cohort. There was no evidence for a substantial change in the incidence rate of HF across the 4 periods (P for trend .29). From 1985 through 2004, there were 457 deaths among 909 subjects with HF. Compared with the period of 1985 to 1989, the age-adjusted hazard ratio of all-cause mortality after onset of HF was 0.61 (0.46-0.81), 0.37 (0.28-0.48), and 0.10 (0.07-0.15) in the second, third, and fourth period, respectively (P for trend <.0001). Additional adjustment for treatment arm, diabetes, myocardial infarction, hypertension, atrial fibrillation, coronary angioplasty or bypass, valvular heart disease, and left ventricular hypertrophy did not alter these results. Similar findings were seen in subjects with HF with and without antecedent myocardial infarction (P for trend <.0001 each). Conclusions Over the past 20 years, we observed a lower risk of all-cause mortality after onset of HF whereas no major change in the incidence of HF was seen among US male physicians.