The proposed project constitutes part of a growing body of research designed to understand not only the secular trends in mortality, morbidity, survival, and disability levels for selected major chronic diseases among older persons in the United States, but also the implications of the findings for health care utilization. Specifically, the application presents plans for a retrospective study of successive cohorts of a well-defined and well-documented elderly population for the purpose of identifying and explaining trends in congestive heart failure (CHF) incidence, survival, comorbidities and health services utilization during the 25-year period 1970-1994. The study sample consists of two successive period cohorts of elderly people, identified for each of two five-year periods, 1970-1974 and 1990-94. The application presents the following hypotheses: 1) incidence of CHF has decreased among the younger old (65-74 years of age); 2) incidence of CHF has increased among the older old (75 years of age or above); 3) one-year survival time has increased following onset of incident CHF; and 4) prevalence of hypertension has decreased and prevalence of myocardial infarction and other manifestations of coronary artery disease have increased among incident cases of CHF. This project builds upon ongoing work of the investigators, related to a number of recent NIH research priorities, including stroke trends (NINDS), hip fracture trends (NIA), and congestive heart failure trends (NHLBI).
