Introduction
Methods
The Swedish Heart Failure Registry
Patient selection and data
Outcome measures
Statistical analysis
Results
Clinical phenotype of DCM over time
Variable | Total (n = 7873) | Period 1 2003–2007 (n = 2029) | Period 2 2008–2011 (n = 3363) | Period 3 2012–2015 (n = 2481) | p value |
---|---|---|---|---|---|
Patient characteristics | |||||
Age (years) | 64.6 (13.5) | 63.9 (13.5) | 64.9 (13.5) | 64.9 (13.6) | 0.022 |
Sex | |||||
Female | 2030 (25.8%) | 456 (22.5%) | 889 (26.4%) | 685 (27.6%) | 0.0001 |
Smoking | |||||
Never | 2548 (38.9%) | 622 (37.8%) | 1094 (39.1%) | 832 (39.3%) | |
Former | 2730 (41.6%) | 685 (41.6%) | 1145 (41.0%) | 900 (42.6%) | |
Current | 1279 (19.5%) | 339 (20.6%) | 557 (19.9%) | 383 (18.1%) | 0.095 |
Clinical measurements | |||||
Weight (kg) | 83.3 (19.6) n = 7385 | 82.9 (18.8) n = 1925 | 83.1 (19.7) n = 3117 | 84.0 (20.0) n = 2343 | 0.066 |
BMI (kg/m2) | 27.4 (7.5) n = 4042 | 27.1 (5.2) n = 942 | 27.1 (5.6) n = 1490 | 27.8 (9.7) n = 1610 | 0.068 |
BMI category (kg/m2) | |||||
≥ 30 | 1125 (27.8%) | 238 (25.3%) | 397 (26.6%) | 490 (30.4%) | 0.0029 |
Systolic blood pressure (mmHg) | 121.1 (19.9) n = 7791 | 120.4 (20.4) n = 2005 | 121.4 (20.0) n = 3324 | 121.3 (19.2) n = 2462 | 0.066 |
Diastolic blood pressure (mmHg) | 73.7 (12.3) n = 7778 | 73.3 (12.8) n = 2004 | 74.0 (12.3) n = 3314 | 73.4 (11.9) n = 2460 | 0.55 |
Heart rate (bpm) | 73.9 (15.1) n = 7438 | 73.3 (14.9) n = 1711 | 73.9 (14.6) n = 3286 | 74.3 (15.8) n = 2441 | 0.16 |
Mean arterial pressure | 89.5 (13.3) n = 7773 | 89.0 (13.7) n = 2001 | 89.8 (13.4) n = 3312 | 89.4 (12.9) n = 2460 | 0.22 |
NYHA class | |||||
I | 775 (12.0%) | 198 (11.5%) | 355 (12.4%) | 222 (11.7%) | |
II | 3031 (46.7%) | 712 (41.3%) | 1335 (46.7%) | 984 (51.7%) | |
III | 2427 (37.4%) | 733 (42.5%) | 1047 (36.6%) | 647 (34.0%) | |
IV | 252 (3.9%) | 80 (4.6%) | 120 (4.2%) | 52 (2.7%) | < 0.0001 |
LVEF | |||||
< 30% | 4455 (60.0%) | 1192 (62.7%) | 1917 (60.7%) | 1346 (57.1%) | |
30–39% | 1700 (22.9%) | 404 (21.2%) | 707 (22.4%) | 589 (25.0%) | |
≥ 40% | 1264 (17.0%) | 306 (16.1%) | 535 (16.9%) | 423 (17.9%) | 0.0014 |
ECG | |||||
Sinus rhythm | 4764 (61.4%) | 1219 (61.2%) | 2027 (61.2%) | 1518 (61.9%) | |
Atrial fibrillation/flutter | 2117 (27.3%) | 579 (29.1%) | 931 (28.1%) | 607 (24.8%) | |
Pacemaker/other rhythm | 872 (11.2%) | 193 (9.7%) | 353 (10.7%) | 326 (13.3%) | 0.0001 |
LBBB | 1917 (29.6%) | 467 (30.1%) | 797 (28.9%) | 653 (30.1%) | 0.88 |
QRS width (ms) | 121.1 (31.2) n = 5552 | 121.0 (32.0) n = 1441 | 119.1 (30.6) n = 2108 | 123.3 (31.0) n = 2003 | 0.0058 |
Laboratory tests | |||||
Haemoglobin (g/L) | 137.7 (16.9) n = 7801 | 137.9 (16.9) n = 2025 | 137.1 (16.8) n = 3359 | 138.3 (17.0) n = 2417 | 0.24 |
Potassium (mmol/L) | 4.20 (0.42) n = 5254 | 4.20 (0.42) n = 641 | 4.19 (0.42) n = 2414 | 4.22 (0.42) n = 2199 | 0.054 |
Creatinine (µmol/L) | 100.8 (49.3) n = 7836 | 105.1 (47.2) n = 2022 | 100.8 (50.1) n = 3359 | 97.3 (49.6) n = 2455 | < 0.0001 |
NT-proBNP (ng/L) | 4503 (6361) n = 3353 | 4365 (6651) n = 404 | 4675 (6385) n = 1352 | 4393 (6266) n = 1597 | 0.85 |
eGFR (ml/min/1.73m2) | 71.0 (24.3) n = 7836 | 69.1 (24.7) n = 2022 | 71.0 (24.7) n = 3359 | 72.7 (23.1) n = 2455 | < 0.0001 |
Medical history from SwedeHF or patient register | |||||
Hypertension | 3729 (47.4%) | 784 (38.6%) | 1642 (48.8%) | 1303 (52.5%) | < 0.0001 |
Diabetes | 1719 (21.8%) | 426 (21.0%) | 741 (22.0%) | 552 (22.2%) | 0.32 |
Atrial fibrillation | 3458 (43.9%) | 885 (43.6%) | 1470 (43.7%) | 1103 (44.5%) | 0.56 |
Lung disease/COPD | 1390 (17.7%) | 349 (17.2%) | 591 (17.6%) | 450 (18.1%) | 0.41 |
Stroke/TIA | 814 (10.3%) | 197 (9.7%) | 336 (10.0%) | 281 (11.3%) | 0.068 |
Liver disease | 290 (3.7%) | 79 (3.9%) | 128 (3.8%) | 83 (3.3%) | 0.32 |
Renal disease | 316 (4.0%) | 75 (3.7%) | 141 (4.2%) | 100 (4.0%) | 0.60 |
Dialysis | 38 (0.5%) | 5 (0.2%) | 19 (0.6%) | 14 (0.6%) | 0.14 |
Peripheral vascular disease | 516 (6.6%) | 124 (6.1%) | 221 (6.6%) | 171 (6.9%) | 0.29 |
Sleep apnoea | 360 (4.6%) | 59 (2.9%) | 140 (4.2%) | 161 (6.5%) | < 0.0001 |
Malignant cancer within last 3 years | 651 (8.3%) | 164 (8.1%) | 280 (8.3%) | 207 (8.3%) | 0.76 |
Musculoskeletal or connective tissue disorder | 1008 (12.8%) | 231 (11.4%) | 448 (13.3%) | 329 (13.3%) | 0.073 |
Medical treatment at discharge | |||||
ACEI | 5716 (73.0%) | 1503 (74.5%) | 2495 (74.7%) | 1718 (69.5%) | < 0.0001 |
ARB | 1894 (24.5%) | 456 (23.1%) | 793 (24.0%) | 645 (26.2%) | 0.013 |
ACEI/ARB | 7349 (93.7%) | 1887 (93.4%) | 3134 (93.6%) | 2328 (94.1%) | 0.34 |
Beta blockers | 7179 (91.7%) | 1806 (89.7%) | 3068 (91.7%) | 2305 (93.4%) | < 0.0001 |
MRA | 3297 (42.2%) | 890 (44.2%) | 1296 (38.8%) | 1111 (45.2%) | 0.32 |
Digoxin | 1367 (17.5%) | 484 (24.1%) | 593 (17.8%) | 290 (11.7%) | < 0.0001 |
Statins | 2968 (37.9%) | 713 (35.4%) | 1295 (38.8%) | 960 (38.9%) | 0.025 |
Loop diuretics | 5697 (74.8%) | 1515 (79.8%) | 2456 (75.5%) | 1726 (70.1%) | < 0.0001 |
Anticoagulants | 3322 (42.5%) | 868 (43.2%) | 1391 (41.6%) | 1063 (43.0%) | 0.96 |
ASA | 2835 (36.4%) | 765 (38.1%) | 1309 (39.3%) | 761 (30.9%) | < 0.0001 |
Nitrates | 620 (7.9%) | 220 (11.0%) | 260 (7.8%) | 140 (5.7%) | < 0.0001 |
Device treatment | |||||
Any device | 1009 (13.0%) | 234 (11.6%) | 408 (12.3%) | 367 (15.1%) | < 0.0001 |
None | 6755 (87.0%) | 1782 (88.4%) | 2911 (87.7%) | 2062 (84.9%) | |
ICD without CRT | 372 (4.8%) | 75 (3.7%) | 153 (4.6%) | 144 (5.9%) | |
CRT without ICD | 269 (3.5%) | 95 (4.7%) | 115 (3.5%) | 59 (2.4%) | |
CRT with ICD | 368 (4.7%) | 63 (3.1%) | 140 (4.2%) | 165 (6.8%) | < 0.0001 |
Treatment of DCM over time
Prognosis of DCM over time
Endpoint | Calendar period | n (%) events | Event rate per 100 person years (95% CI) | Event rate per 100 person years (95% CI) adjusted for age and sex |
---|---|---|---|---|
All-cause mortality | 2003–2015 | 881 (11.2%) | 12.0 (11.2–12.8) | 8.9 (8.1–9.7) |
Period 1 | 254 (12.5%) | 13.6 (12.0–15.4) | 10.7 (9.3–12.2) | |
Period 2 | 365 (10.9%) | 11.6 (10.4–12.8) | 8.3 (7.4–9.3) | |
Period 3 | 262 (10.6%) | 11.3 (10.0–12.8) | 8.1 (7.1–9.3) | |
Transplantation | 2003–2015 | 55 (0.7%) | 0.8 (0.6–1.0) | 0.4 (0.3–0.6) |
Period 1 | 10 (0.5%) | 0.5 (0.3–1.0) | 0.3 (0.1–0.5) | |
Period 2 | 30 (0.9%) | 1.0 (0.6–1.4) | 0.5 (0.3–0.8) | |
Period 3 | 15 (0.6%) | 0.6 (0.4–1.1) | 0.4 (0.2–0.6) | |
HF hospitalization | 2003–2015 | 2406 (30.6%) | 40.8 (39.2–42.5) | 40.8 (39.2–42.4) |
Period 1 | 659 (32.5%) | 44.8 (41.5–48.4) | 45.0 (41.7–48.6) | |
Period 2 | 1050 (31.2%) | 41.7 (39.2–44.3) | 41.6 (39.2–44.2) | |
Period 3 | 697 (28.1%) | 36.5 (33.9–39.3) | 36.4 (33.8–39.2) | |
CV hospitalization | 2003–2015 | 3091 (39.3%) | 56.7 (54.7–58.8) | 56.5 (54.5–58.5) |
Period 1 | 831 (41.0%) | 61.4 (57.3–65.7) | 61.8 (57.7–66.2) | |
Period 2 | 1373 (40.8%) | 59.7 (56.5–62.9) | 59.2 (56.1–62.4) | |
Period 3 | 887 (35.8%) | 49.4 (46.2–52.8) | 49.1 (45.9–52.4) | |
Any hospitalization | 2003–2015 | 3540 (45.0%) | 68.3 (66.0–70.5) | 68.0 (65.8–70.3) |
Period 1 | 947 (46.7%) | 73.8 (69.2–78.7) | 74.6 (70.0–79.5) | |
Period 2 | 1580 (47.0%) | 72.6 (69.0–76.2) | 72.0 (68.5–75.6) | |
Period 3 | 1013 (40.8%) | 58.7 (55.1–62.4) | 58.2 (54.7–61.9) | |
Composite endpoint | 2003–2015 | 3810 (48.4%) | 73.5 (71.2–75.8) | 72.9 (70.6–75.3) |
Period 1 | 1024 (50.5%) | 79.8 (75.0–84.9) | 80.6 (75.8–85.7) | |
Period 2 | 1681 (50.0%) | 77.2 (73.5–81.0) | 76.2 (72.6–80.0) | |
Period 3 | 1105 (44.5%) | 64.0 (60.3–67.9) | 63.1 (59.5–66.9) |