Generic and disease-specific quality of life as a predictor of long-term mortality in heart failure.

AIMS: Although the vital prognosis of heart failure (HF) is generally poor, it varies substantially between patients. This study examined whether health-related quality of life (HRQoL) predicts long-term mortality in HF. It also evaluated the role of generic and disease-specific HRQoL questionnaires. METHODS AND RESULTS: We studied 416 patients admitted for HF-related emergencies to four hospitals in Spain in 2000-2001. Health-related quality of life was measured at study baseline with a generic questionnaire, the SF-36, and with a disease-specific one, the Minnesota Living with Heart Failure (MLWHF) questionnaire. Patients were followed prospectively to 2007 to ascertain all-cause mortality. During follow-up, 290 (69.7%) patients died. After adjustment for biomedical, healthcare, and social variables, a poor mental component summary (MCS) score on the SF-36 was associated with higher mortality [hazard ratio (HR) 1.38; 95% confidence interval (CI) 1.06-1.76]. For MLWHF, a poor physical component summary (PCS) score predicted higher mortality (HR 1.31; 95% CI 1.01-1.70). In a stepwise Cox model that included the PCS scores of both the SF-36 and the MLWHF, only the PCS of the MLWHF was retained with P<0.05. However, when both MCS scores were included, only the MCS of the SF-36 was retained with P<0.05. CONCLUSION: The SF-36 MCS and the MLWHF PCS predict long-term mortality in patients with HF. Future research should identify the determinants of HRQoL and refine interventions to improve it.

[Cardiovascular mortality attributable to high blood pressure in Spanish population over 50]. / Mortalidad cardiovascular atribuible a la presión arterial elevada en la población española de 50 años o más.

BACKGROUND AND OBJECTIVE: Cardiovascular mortality attributable to high blood pressure in Spain is not available at present. PATIENTS AND METHOD: Population attributable risk and number of cardiovascular deaths attributable to high systolic blood pressure (> or = 120 mmHg) were estimated for the Spanish population aged 50-89 years, according to classical formulae. Relative risk data were drawn from the Prospective Studies Collaboration, meta-analysis of 61 studies on blood pressure and mortality, with data on one million subjects (30,000 from South Europe) with no prior vascular disease. Blood pressure prevalence was drawn from 2 nationwide surveys in Spain, for subjects aged 50-59 years and 60-89 years old, respectively. Cardiovascular deaths occurred in Spain were drawn from official statistics (year 2004). RESULTS: The number of annual cardiovascular deaths attributable to high blood pressure was 44,401, which represents 54% of the carFdiovascular deaths occurred in people over 50 years: 17,312 for ischemic heart disease, 15,599 for stroke, and 11,490 for other cardiovascular diseases. The highest number of attributable deaths lie in hypertension grade 1 and 2 (32,638) and in those over 70 years (36,345). Normal and high-normal blood pressure accounted for 6% of all attributable cardiovascular deaths. CONCLUSIONS: One in 2 cardiovascular deaths occurred annually in Spanish individuals over 50 years are attributable to high blood pressure, 90% of them are attributable to hypertension.

Mortalidad cardiovascular atribuible a la presión arterial elevada en la población española de 50 años o más / Cardiovascular mortality attributable to high blood pressure in Spanish population over 50

FUNDAMENTO Y OBJETIVO: No se dispone de información actual sobre la mortalidad cardiovascularatribuible a la presión arterial elevada en España.PACIENTES Y MÉTODO: Se han estimado, mediante fórmulas convencionales, los riesgos atribuiblespoblacionales y el número de muertes cardiovasculares relacionadas con cifras elevadas de presiónarterial sistólica ( 120 mmHg) en la población de 50-89 años de España. Los datos sobre riesgos relativos proceden del Prospective Studies Collaboration, metaanálisis de 61 estudios de presión arterial y mortalidad, con datos de un millón de personas (30.000 del sur de Europa) sin antecedentes de enfermedad vascular. Las prevalencias de la presión arterial proceden de 2 estudios representativos de la población española para personas de 50-59 y 60-89 años de edad, respectivamente. El número de muertes de causa cardiovascular ocurridas se ha tomado del Instituto Nacional de Estadística (año 2004).RESULTADOS: Anualmente un total de 44.401 muertes de causa cardiovascular son atribuibles a la presión arterial elevada, lo que representa el 54% de la mortalidad cardiovascular en mayores de 50 años: 17.312 por cardiopatía isquémica, 15.599 por enfermedad cerebrovascular y 11.490 por otras enfermedades cardiovasculares. El mayor número de muertes atribuibles corresponde a las categorías de hipertensión grados 1 y 2 (32.638) y a los mayores de 70 años (36.345), y las presiones normal y normal-alta explican un 6% de todas las muertes atribuibles.CONCLUSIONES: Una de cada 2 muertes de causa cardiovascular ocurridas anualmente a los individuosmayores de 50 años son atribuibles a la presión arterial elevada, y el 90% de ellas son atribuibles a la hipertensión

BACKGROUND AND OBJECTIVE: Cardiovascular mortality attributable to high blood pressure in Spainis not available at present.PATIENTS AND METHOD: Population attributable risk and number of cardiovascular deaths attributableto high systolic blood pressure ( 120 mmHg) were estimated for the Spanish population aged 50-89 years, according to classical formulae. Relative risk data were drawn from the Prospective Studies Collaboration, meta-analysis of 61 studies on blood pressure and mortality,with data on one million subjects (30,000 from South Europe) with no prior vascular disease. Blood pressure prevalence was drawn from 2 nationwide surveys in Spain, for subjects aged 50-59 years and 60-89 years old, respectively. Cardiovascular deaths occurred in Spain were drawn from official statistics (year 2004).RESULTS: The number of annual cardiovascular deaths attributable to high blood pressure was 44,401, which represents 54% of the cardiovascular deaths occurred in people over 50 years: 17,312 for ischemic heart disease, 15,599 for stroke, and 11,490 for other cardiovascular diseases. The highest number of attributable deaths lie in hypertension grade 1 and 2 (32,638) and in those over 70 years (36,345). Normal and high-normal blood pressure accounted for 6% of all attributable cardiovascular deaths.CONCLUSIONS: One in 2 cardiovascular deaths occurred annually in Spanish individuals over 50 years are attributable to high blood pressure, 90% of them are attributable to hypertension