Context The epidemic of heart failure has yet to be fully investigated, and
data on incidence, survival, and sex-specific temporal trends in community-based
populations are limited.
Objective To test the hypothesis that the incidence of heart failure has declined
and survival after heart failure diagnosis has improved over time but that
secular trends have diverged by sex.
Design, Setting, and Participants Population-based cohort study using the resources of the Rochester Epidemiology
Project conducted in Olmsted County, Minnesota. Patients were 4537 Olmsted
County residents (57% women; mean [SD] age, 74  years) with a diagnosis
of heart failure between 1979 and 2000. Framingham criteria and clinical criteria
were used to validate the diagnosis
Main Outcome Measures Incidence of heart failure and survival after heart failure diagnosis.
Results The incidence of heart failure was higher among men (378/100 000
persons; 95% confidence interval [CI], 361-395 for men; 289/100 000 persons;
95% CI, 277-300 for women) and did not change over time among men or women.
After a mean follow-up of 4.2 years (range, 0-23.8 years), 3347 deaths occurred,
including 1930 among women and 1417 among men. Survival after heart failure
diagnosis was worse among men than women (relative risk, 1.33; 95% CI, 1.24-1.43)
but overall improved over time (5-year age-adjusted survival, 43% in 1979-1984
vs 52% in 1996-2000, P<.001). However, men and
younger persons experienced larger survival gains, contrasting with less or
no improvement for women and elderly persons.
Conclusion In this community-based cohort, the incidence of heart failure has not
declined during 2 decades, but survival after onset of heart failure has increased
overall, with less improvement among women and elderly persons.