Heart failure is a syndrome of profound clinical and public health importance. Heart failure (HF) afflicts more than 2 million persons in the U.S. and contributes to more than 500,000 hospitalizations and nearly 250,000 deaths annually. The number of new cases of HF in the U.S. is estimated to exceed 400,000 annually, though extremely limited and recent population-based data are available to provide current estimates of the magnitude and mortality associated with HF. HF is associated with a grim prognosis and there are little data to indicate whether survival from HF has improved in recent years. Virtually no data are available about the epidemiology of HF in minority populations. This pilot study proposes to determine the feasibility for establishing an eventual surveillance system in two Northeast cities (Worcester and Springfield, MA) for monitoring trends in the incidence rates of HF, its diagnostic evaluation and therapeutic management, time course and magnitude of hospital readmissions and use of outpatient care, as well as trends in in-hospital and long-term survival from a multi-hospital population-based perspective. This pilot study will take place in residents of the city of Worcester, MA (1990 census estimates = 170,000) hospitalized with a discharge diagnosis of HF, and HF related diagnostic rubrics, in 1996 at all three Worcester hospitals. The ambulatory care records of a sample of patients treated for HF at the Fallon Clinic, the largest group-model HMO in central Massachusetts, as well as on an outpatient basis at the three Worcester hospitals, will also be reviewed to determine the extent of information available in outpatient medical records with regard to HF. The proposed project will build on the investigators' clinical and epidemiological experience as well as on data collection efforts and methodologies used in the ongoing community- wide surveillance study of coronary heart disease in metropolitan Worcester residents (Worcester Heart Attack Study). To accomplish the study objectives, a random sample of the medical records of Worcester residents hospitalized with a discharge diagnosis of HF and related disease diagnoses in 1996 will be individually reviewed and validated according to pre-established criteria (updated Framingham Study criteria). Outpatient records will similarly be reviewed to examine the extent of available and useful information related to HF contained in these records. The yield of numerous discharge diagnostic rubrics for cases of validated HF will be determined to provide a framework for sample selection in future surveillance efforts of this prevalent clinical syndrome. The results of this pilot feasibility study will determine the utility of using hospital and ambulatory care records to establish surveillance for HF in two large and representative Massachusetts communities. Important insights from a population-based surveillance study would be provided to the descriptive and analytical epidemiology of HF in men and women, different age groups, as well as in whites, blacks and hispanics.
