MUNICH — Five-year survival of patients with heart failure has been dire, worse than for many cancers. But therapeutic advances in the last 2 decades mean that today, for the first time, that's no longer true, according to a large Swedish study.
“Heart failure has become less malignant than the most common forms of cancer at the population level,” Simon Stewart, Ph.D., said at the annual congress of the European Society of Cardiology.
Indeed, while most cancer-related survival rates have improved substantially in Sweden, as elsewhere, during the last 2 decades—with the glaring exception of lung cancer—heart failure survival rates have increased at twice the pace.
“Heart failure survival rates are now equivalent to those for large bowel cancer,” added Dr. Stewart, head of preventive cardiology at the Baker Heart Research Institute, Melbourne.
He presented a population-based study of 770,484 patients hospitalized in 19 Swedish counties during 1988–1999 for heart failure, acute MI, or the six most common types of cancer. Collectively, these counties included 85% of the nation's population.
A total of 321,951 patients were admitted for heart failure, while 218,664 were hospitalized for large bowel, prostate, breast, lung, bladder, or ovarian cancer.
Thus, heart failure was roughly 50% more common than were all six common cancers as a cause of hospital admission.
Among patients aged 60 years, 5-year survival was 70% in men and 75% in women with heart failure, compared with 57% in men and 61% in women with large bowel cancer. In contrast, 5-year survival in 60-year-olds with lung cancer was 18% in men and 20% in women.
Here's how the prognosis for heart failure improved during 1988–1999: Each year during the study period, 5-year survival increased by an average of 7.1% in men and by 6% in women with heart failure.
Meanwhile, 5-year survival improved by 3% per year in patients with large bowel or breast cancer. The prognosis for lung cancer remained unchanged.
Dr. Stewart observed that this study may actually underestimate the survival gains in heart failure patients. Evidence indicates Swedish primary care physicians have assumed a more active role in managing heart failure. They are making a strong effort to keep patients out of the hospital.
Thus, the admission threshold has probably increased over the past couple of decades, and it's likely many patients present in the hospital with more advanced heart failure than was formerly the case.