European Journal of Heart Failure (2013) 15, 995–1002

doi:10.1093/eurjhf/hft064

The epidemiology of heart failure, based on data

for 2.1 million inhabitants in Sweden
Ramin Zarrinkoub 1,2,3*, Björn Wettermark 2,4, Per Wändell 1, Märit Mejhert 5,6,
Robert Szulkin 1,7, Gunnar Ljunggren2,8, and Thomas Kahan 6,9
1
Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Huddinge, Sweden; 2Public Healthcare Services Committee Administration,
Stockholm County Council, Stockholm, Sweden; 3Storvreten Primary Health Care Centre, Stockholm, Sweden; 4Karolinska Institutet, Department of Medicine, Unit for Clinical
Epidemiology, Centre for Pharmacoepidemiology, Stockholm, Sweden; 5Department of Medicine, Ersta Hospital, Stockholm, Sweden; 6Karolinska Institutet, Department of Clinical
Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden; 7Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden;
8
Karolinska Institutet, Department of Learning, Medical Management Centre, Informatics, Management and Ethics, Stockholm, Sweden; and 9Department of Cardiology, Danderyd
University Hospital, Stockholm, Sweden

Received 18 December 2012; revised 22 March 2013; accepted 5 April 2013; online publish-ahead-of-print 3 May 2013

Aims The epidemiology of congestive heart failure (CHF) is likely to have changed due to changes in demography, risk factors,
diagnostic procedures, and medical care. Prevailing information is in part old, incomplete, and to some extent contradict-
ory. We determined the current prevalence, incidence, mortality, and 5-year survival rate of CHF, and possible temporal
changes in Sweden.
.....................................................................................................................................................................................
Methods This was a cross-sectional study on individual patient data from an administrative health data register in the Stockholm
and results region, Sweden, comprising 2.1 million inhabitants. This contained all recorded diagnoses on all consultations in
primary and secondary care (defined as specialist outpatient care), and on all hospitalizations. Prevalence, incidence,
and mortality were estimated for the entire Swedish population, adjusted for demographic composition in 2010. The
study population consisted of 88 038 patients (51% women). The prevalence was 2.2% (both women and men), the in-
cidence was 3.8/1000 person-years (both women and men), and mortality was 3.2/1000 person-years in women and 3.0/
1000 person-years in men (P , 0.001); the 5-year survival rate was 48%. Mortality (age adjusted; hazard ratio and 95%
confidence intervals) was higher in men, 1.29, 1.24—1.34; P , 0.001. Prevalence remained essentially unchanged from
2006 to 2010, while incidence decreased by 24% (P , 0.001) and mortality by 19% (both women and men; P , 0.001).
.....................................................................................................................................................................................
Conclusions The estimated prevalence of CHF in Sweden is 2.2%, incidence 3.8/1000 person-years, and mortality 3.1/1000 person-
years. There has been a decrease in incidence and mortality from 2006 to 2010 in both women and men, with no major
change in prevalence over time.
-----------------------------------------------------------------------------------------------------------------------------------------------------------
Keywords Epidemiology † Heart failure † Incidence † Mortality † Prevalence † Survival

abnormality of cardiac structure or function.5 However, the diagnosis

Introduction
Congestive heart failure (CHF) is a leading cause of morbidity, hospi-
talizations, disability, and death.1,2 The prevalence and incidence in-
crease with age, and the costs of care and treatment of CHF
constitute a considerable burden for healthcare.1,3 Thus, the direct
costs of CHF account for  2% of the total healthcare budget in
many European countries.4
According to current recommendations, a diagnosis of CHF
requires typical symptoms and signs, together with evidence for an
of CHF can be difficult, as symptoms and signs are not specific.5 The
epidemiology of CHF is likely to have changed during recent years
due to changes in demography, and changes in prevalence, treatment,
and control of contributing risk factors (e.g. hypertension and ischae-
mic heart disease).6,7 There may also be other important reasons,
such as changes in diagnostic criteria of CHF and in the survival
among prevalent cases.8 – 11
Recent studies suggest a prevalence of 1–3% in CHF.12,13 There is
divergent information on temporal changes in the prevalence of

* Corresponding author. Karolinska Institutet, Centre for Family Medicine, Alfred Nobels Allé 12, S-141 83 Huddinge, Sweden. Tel: +46 8 524 800 00, Fax: +46 8 524 887 06,
Email: ramin.zarrinkoub@priv.sll.se
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email: journals.permissions@oup.com.
996
CHF.2,14,15 Reports on the incidence of CHF and possible temporal
changes provide contradictory results but suggest an incidence of
1 –4/1000 person-years.1,9,16,17 Although the 5-year mortality rate
for patients with CHF remains high, most studies suggest a decrease
in mortality in recent years.9,16,17
In Sweden, the prevalence of CHF has been estimated to be
2.5%,18,19 and CHF was recorded as the cause of death in 3.4% of
women and 2.4% of men.18 Mortality data from Sweden suggest a
mortality rate of 30–36% within 1 year following discharge from hos-
pital.20 However, these data are based on studies conducted
. 20 years ago. Current and reliable information on CHF epidemi-
ology including patients from primary, secondary, and hospital care
is sparse.
The developments of electronic medical records and administra-
tive databases have facilitated epidemiological studies.21 Sweden
has a long tradition of research on high quality health registries
with almost complete reporting.22 – 24 Thus, the aims of this study
were to determine the current prevalence, incidence, mortality,
and 5-year survival rate of CHF in Sweden and their possible tem-
poral changes from 2006 to 2010.
Methods
The region of greater Stockholm, Sweden, comprised . 2.1 million inha-
bitants in 2010. The administrative health data register of this region
(Vårdanalysdatabasen, VAL; Stockholm regional healthcare data ware-
house) contains all consultations in primary and secondary care
(defined as specialist outpatient care), and all hospitalizations. Data for
primary care are available from 2003, and for secondary care and hospi-
talization from 1993. The International Classification of Diseases Version
10 (ICD-10) diagnostic coding system has been used in Sweden since
1997.
The study population of this cross-sectional investigation included all
patients in the Stockholm region who were recorded with a primary or
secondary diagnosis of CHF (ICD-10 code I50) on at least one consult-
ation in primary care (from 2003 to 2010), secondary care (from 1997
to 2010), or during hospitalization (from 1997 to 2010). Patients never
living in Stockholm during the study period and patients with an invalid
Swedish person identity number were excluded.
We identified co-morbid conditions for prevalent patients in 2010 by
searching recorded diagnoses for chronic obstructive pulmonary disease
(COPD) (J40– J44), cerebrovascular disease (I60– I64, I67.8, I67.9, G45 –
G46), diabetes (E10 – E14), atrial fibrillation/flutter (I48.9), hypertension
(I10 – I15), and ischaemic heart disease (I20– I25) in primary care (from
2003 to 2010), secondary care, and hospitals (from 1997 to 2010).
Results are given as crude values for the Stockholm region and as esti-
mated values for the entire Swedish population, adjusted for the demo-
graphic composition in 2010. To assess temporal changes in prevalence
and incidence, equal length run-in periods were applied for data on sec-
ondary care and hospital care in order to obtain comparable cohorts. For
data from primary care, however, applying equal length run-in periods
would introduce bias in the calculations because of the short period of
historical data (i.e. from 2003 to 2010). The date for onset of CHF was
defined as the first occasion with a recorded diagnosis of CHF by any
of the healthcare providers. Five-year survival was calculated for all inci-
dent cases between 1 January 2006 and 31 December 2010, and all-cause
mortality was used for the calculations. Patients who had moved out of
the region during this time period, and all who were alive on 31 Decem-
ber 2010 were censored.
R. Zarrinkoub et al.
The investigation conforms to the principles outlined in the Declar-
ation of Helsinki. The regional Ethical Review Board in Stockholm
approved the study. All data were extracted electronically and obtained
in anonymous and non-identifiable form.
Statistical methods
Data are presented as mean values + SD, where appropriate. Differ-
ences between groups were assessed by the Student’s t-test or the
Mann– Whitney test for continuous variables, as appropriate, and the
x2 test for categorical variables. Crude prevalence (in December
2010), incidence, and mortality for 2010 were calculated by dividing
the number of patients by the total number of inhabitants (i.e.
2 056 173) in Stockholm County on December 2010. No consideration
was made for migration to and from the region. A Poisson regression
model adjusting for age (fit as a quadratic term) was used to evaluate
trend changes in prevalence, incidence, and mortality between 2006
and 2010.The demographic composition in 2006 was used as reference.
Life table curves according to Kaplan – Meier were calculated and com-
pared using log-rank tests, and Cox proportional hazards regression
was used to account for age, gender, and co-morbidity. For comparison,
the 5-year survival trends in the entire Swedish population were taken
from Statistics Sweden.25 A probability (P) ,0.05 was considered signifi-
cant. Data management was performed in MS Access (Microsoft Corpor-
ation, Redmond, WA, USA) and statistical analyses in STATA version 11
(Stata Corporation, College Station, TX, USA).
Results
Prevalence
In all, 88 038 patients (51% women) were found with a diagnosis of
CHF. The crude prevalence of CHF in 2010 was 1.8%, similar in
women and men. After adjustment for demographic composition,
the estimated prevalence in Sweden was 2.2%. The mean age for
the prevalent patients in 2010 (n ¼ 36 420) was 77 + 13 years
(women 80 + 12 years, men 74 + 13 years; P , 0.001). More than
90% of the patients were 60 years or older. The prevalence among
men exceeded that among women for all age groups, except
those ≥ 100 years of age (Figure 1). Characteristics for prevalent
patients in 2010 and in 2006 are summarized in Table 1. The propor-
tion of all consultations or hospitalizations, by different care provi-
ders, for the prevalent patients in 2010 is shown in Figure 2. Of
note, 17% of the patients only attended primary care.
The prevalence of CHF between 2006 and 2010 showed a weak
decreasing temporal trend in women (P ¼ 0.044) but did not
change in men (P ¼ 0.25) (Table 2, Figure 3).
Incidence
The crude incidence in 2010 was 3.1/1000 person-years, similar in
women and men. After adjustment for demographic composition,
the estimated incidence in Sweden was 3.7/1000 person-years in
women and 3.9/1000 person-years in men (P , 0.001). The mean
age by the first recorded diagnosis of CHF for the incident patients
in 2010 was 77 + 13 years (women 80 + 12 years, men 74 + 13
years; P , 0.001). There was a decreasing temporal trend by 0.9/
1000 person-years in absolute terms (i.e. a relative 24% decrease,
P , 0.001) between 2006 and 2010 (Table 3, Figure 3). This trend
was not different between women and men.
The epidemiology of heart failure in Sweden 997

Figure 1 The solid line represents the number of patients with congestive heart failure according to age group. The prevalence according to age
group is presented for women (open bars) and men (filled bars).

Table 1 Characteristics of prevalent patients with congestive heart failure in 2006 and 2010

2006 2010
.................................... ....................................
Women Men P-value Women Men P-value
...............................................................................................................................................................................
Number 18 231 16 731 18 542 17 878
Age, years 81 + 12 74 + 13 ,0.001 80 + 12 74 + 13 ,0.001
Age of onset, years 77 + 12 70 + 13 ,0.001 76 + 13 70 + 13 ,0.001
Duration of CHF, years 4.0 + 2.9 4.1 + 2.9 4.5 + 3.4 4.7 + 3.5
Concomitant disease, %
Hypertension 67 65 ,0.001 73 69 ,0.001
Ischaemic heart disease 54 64 ,0.001 47 56 ,0.001
Atrial fibrillation/flutter 49 54 ,0.001 43 48 ,0.001
Diabetes mellitus 27 33 ,0.001 24 30 ,0.001
Cerebrovascular disease 28 28 21 22 0.017
COPD 22 23 20 18

Mean values + SD or proportions, as appropriate. P denotes a significant difference between women and men.
CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease.

Mortality and survival
The crude all-cause mortality in 2010 was 2.5/1000 person-years,
higher in women than in men (2.7 and 2.3/1000 person-years, re-
spectively, P , 0.001). After adjustment for demographic compos-
ition, the estimated mortality in Sweden was 3.1/1000
person-years, higher in women than in men (3.2 and 3.0/1000
person-years, respectively, P , 0.001). The mean age for death
for the CHF patients in 2010 was 85 + 10 years (women 87 +
9 years, men 83 + 10 years, P , 0.001). Mortality decreased by
0.5/1000 person-years in absolute terms (i.e. a 19% relative de-
crease; P , 0.001) between 2006 and 2010, in both women and
men (Table 4, Figure 3).
998 R. Zarrinkoub et al.

The 5-year survival rate from the first recorded diagnosis was 48%
(45% in women and 51% in men; P , 0.05). These values are lower
than for the age-matched entire Swedish population (Table 5). The
risk of death for any reason after a recorded diagnosis of CHF was
lower in men than in women (hazard ratio and 95% confidence inter-
val 0.95, 0.92– 0.99; P ¼ 0.012). However, when age was accounted
for, the risk was higher in men than in women: 1.29, 1.24 –1.34,
P , 0.001. This higher risk also remainded unchanged after adjust-
ment for co-morbidities (data not shown).
Co-morbidities
Hypertension was the most common cardiovascular co-morbidity,
followed by ischaemic heart disease, atrial fibrillation/flutter, diabetes
mellitus, cerebrovascular disease, and COPD (Table 1). The 5-year
Figure 2 The proportions of all 36 420 prevalent patients with
congestive heart failure in 2010, who had attended primary care
(2003 – 2010), secondary care (defined as specialist outpatient
care; 1997 – 2010), or had been hospitalized (1997 – 2010).
survival adjusted for age was related to pre-existing co-morbidity, as
illustrated in Figure 4.
Discussion
The crude prevalence of CHF in Stockholm was 1.8%. The preva-
lence was estimated to be 2.2% in Sweden in 2010 after adjustment
for demographic composition. The prevalence appeared essentially
unchanged from 2006 to 2010. Earlier studies of community-based
cohorts suggest an increased prevalence of CHF, but the rate of in-
crease has become slower over time.14 Indeed, as CHF mostly
affects elderly people and in view of the fact that the population in
western countries is ageing, the prevalence of CHF is likely to in-
crease. On the other hand, the improved control of risk factors
such as hypertension and ischaemic heart disease has probably
resulted in a lower incidence of CHF, which together with improved
survival has maintained the prevalence rates unchanged.6,26
However, our results do not provide information on the possible
contribution of various factors to these findings.27 Contributing
factors to this trend deserve further study.
The crude incidence of CHF in 2010 in this study was 3.1/1000. The
incidence was estimated to be 3.7/1000 in Sweden in 2010 after ad-
justment for demographic composition. There was a 0.9/1000 abso-
lute decrease (i.e. a relative 24% decrease, P , 0.001) from 2006 to
2010 in both women and men. Although earlier studies predicted
an increase of CHF incidence due to an ageing population and
improved survival in ischaemic heart disease,28 more recent data
suggest that improved survival in acute coronary syndromes is not
a major contributor to the incidence of CHF.15 The Olmsted
County Study reported no change in CHF incidence between 1979
and 2000.9 However, our results support observations from the Fra-
mingham Heart Study, where the incidence of CHF in women
declined by 30 –40% from 1950 to 1999, whereas the incidence in
men remained unchanged. Improved treatment and control of risk
factors may have contributed to the reduction in CHF incidence sug-
gested by our results.

Table 2 The age-adjusted prevalence of congestive heart failure, by age and gender

Age 2006 2007 2008 2009 2010

...................... ...................... ...................... ...................... ......................
Women Men Women Men Women Men Women Men Women Men Total Crude
...............................................................................................................................................................................
40–49 0.1 0.3 0.1 0.3 0.2 0.3 0.2 0.3 0.2 0.3 0.2 0.2
50–59 0.5 1.1 0.5 1.1 0.5 1.2 0.5 1.2 0.5 1.2 0.9 0.9
60–69 1.6 3.6 1.5 3.4 1.5 3.3 1.5 3.1 1.4 3.1 2.3 2.6
70–79 6.4 10.0 6.4 9.6 6.2 9.2 6.0 8.7 5.80 8.2 6.9 7.5
80–89 17.93 21.4 17.9 21.2 18.3 21.5 18.2 21.6 18.2 21.6 19.5 18.8
≥90 33.0 36.9 32.7 34.3 30.9 32.7 31.8 33.0 29.4 30.3 29.7 34.4
Total 1.9 1.8 1.8 1.7 1.8 1.7 1.7 1.7 1.7 1.6 1.7 1.8

The age-adjusted prevalence of congestive heart failure (expressed as a percentage) in Stockholm, Sweden, from 2006 to 2010 for women and men, and for the total population
(for 2010 only). The demographic composition in 2006 was used as a reference for adjustment of the prevalence values. There was a weak decreasing temporal trend, calculated by
Poisson regression model, in women (P ¼ 0.044) but not in men (P ¼ 0.25).
Also shown is the crude prevalence for 2010 in Stockholm. The estimated crude prevalence for Sweden in 2010, adjusted for demographic composition, was 0.2, 0.9, 2.9, 9.7, 24.5, 38.9,
and 2.2 for age categories 40 –49 to ≥90 years and the total, respectively.
The epidemiology of heart failure in Sweden 999

Figure 3 Temporal trends in prevalence, incidence, and all-cause mortality from 2006 to 2010. The demographic composition in 2006 was used as
a reference for adjustment for all values.

Table 3 The age-adjusted incidence of congestive heart failure, by age and gender

Age 2006 2007 2008 2009 2010

...................... ...................... ...................... ...................... ......................
Women Men Women Men Women Men Women Men Women Men Total Crude
...............................................................................................................................................................................
40– 49 0.3 0.6 0.3 0.6 0.3 0.6 0.2 0.6 0.2 0.5 0.4 0.4
50– 59 1.1 2.4 1.2 2.2 1.0 2.1 0.8 2.2 1.0 2.1 1.6 1.6
60– 69 3.5 7.0 3.4 5.8 3.1 5.7 2.9 4.8 2.3 5.2 3.7 4.2
70– 79 14.4 19.1 14.2 17.5 12.6 16.8 12.0 14.9 10.7 13.2 11.9 13.0
80– 89 35.2 43.4 34.8 41.1 35.0 42.6 34.6 39.5 31.0 38.2 33.7 32.7
≥90 57.4 71.7 52.9 62.6 49.6 60.3 51.4 56.4 42.5 51.5 45.0 52.1
Total 3.9 3.6 3.7 3.3 3.5 3.3 3.3 3.0 2.9 2.9 2.9 3.1

The age-adjusted incidence of congestive heart failure (expressed in cases/1000 person-years) in Stockholm, Sweden, from 2006 to 2010, for women and men, and for the total
population (for 2010 only). The demographic composition in 2006 was used as a reference for adjustment of the incidence values. The temporal trend for incidence, calculated by
Poisson regression model, was significant in both women (P , 0.001) and men (P , 0.001). The crude incidence of congestive heart failure (expressed in cases/1000 person-years) in
2010 is only for the total. The estimated crude incidence for Sweden in 2010, adjusted for demographic composition, was 0.4, 1.7, 4.8, 16.7, 42.6, 58.9, and 3.8 per 1000 person-years for
age categories 40 –49 to ≥90 years and the total, respectively.

We observed a crude mortality in 2010 of 2.5/1000, higher
in women than in men. However, women were older, and, when
adjusted for age, mortality turned out to be higher in men,
which agrees well with previous studies.9,17 After adjustment for
demographic composition, the estimated mortality in Sweden
was 3.1/1000 person-years. There was an absolute 0.5/1000
decrease in mortality (i.e. a 19% relative decrease; P , 0.001)
from 2006 to 2010. A decrease in mortality is in agreement with
most previous studies.9,11,17 This may be attributable to improve-
ment in medical treatment in CHF.10,16 Despite similar temporal
1000 R. Zarrinkoub et al.

Table 4 The age-adjusted all-cause mortality of patients with congestive heart failure by age and gender

Age 2006 2007 2008 2009 2010

....................... ....................... ....................... ....................... .......................
Women Men Women Men Women Men Women Men Women Men Total Crude
...............................................................................................................................................................................
40–49 0.1 0.1 0.0 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0
50–59 0.2 0.5 0.1 0.4 0.1 0.4 0.2 0.3 0.2 0.4 0.3 0.3
60–69 0.9 2.3 0.9 2.0 1.0 2.0 0.8 1.5 0.8 1.7 1.2 1.2
70–79 5.7 10.4 5.5 10.1 4.7 9.3 4.4 8.3 4.5 7.8 6.1 6.7
80–89 27.6 44.7 28.3 41.3 27.5 39.0 24.7 37.6 26.4 37.6 30.7 29.7
≥90 106.6 145.6 108.2 135.6 92.2 125.7 92.6 118.3 83.1 106.5 89.7 104.0
Total 3.1 2.7 3.1 2.5 2.8 2.3 2.6 2.2 2.6 2.1 2.4 2.5

Age-adjusted all-cause mortality for women and men (expressed in cases/1000 person-years) in Stockholm, Sweden, from 2006 to 2010, and for the total population (only for 2010).
The demographic composition in 2006 was used as a reference for the adjustment of the mortality values. The temporal trend for mortality for 2006–2010 was significant in women
(P , 0.001) and in men (P , 0.001). The estimated crude mortality for Sweden in 2010, adjusted for demographic composition, was 0.0, 0.3, 1.6, 8.6, 38.7, 117.6, and 3.1 per 1000
person-years for age categories 40 –49 to ≥90 years and the total, respectively.

Table 5 Five-year survival estimates in patients with congestive heart failure, as compared with the entire Swedish
population, by age and gender

Age Women Men Total

................................................ ................................................ ................................................
Entire population Heart failure Entire population Heart failure Entire population Heart failure
...............................................................................................................................................................................
40–49 99 89 99 90 99 90
50–59 98 70 97 83 97 78
60–69 95 76 94 69 94 71
70–79 86 63 82 54 82 59
80–89 58 36 55 34 55 35
≥90 23 16 22 10 22 15
Total 95 45 95 51 95 48

Five-year survival estimates from 2006 to 2010 (expressed as a percentage) for women and men, as compared with the entire Swedish population. The numbers of patients in each age
group were 686 (40–49 years), 2009 (50 –59 years), 5039 (60 –69 years), 8648 (70 – 79 years), 13 115 (80 –89 years), and 4143 (≥90 years). Five-year survival was calculated from the
moment of the first recorded diagnosis of congestive heart failure, and by all-cause mortality. The difference in 5-year survival between patients with congestive heart failure and the
entire Swedish population was significant (P , 0.001) in all age groups, in both women and men.

trends, there are some differences to the mortality rates previously
reported. These differences are most probably due to differences
in the selection of patients and the definitions of CHF used.29
The results of this study are based on data from 2.1 million sub-
jects, which comprise close to a quarter of the population in
Sweden. Data were obtained unbiased from a unique database
(i.e. the Stockholm regional healthcare data warehouse), which
contains details of almost all healthcare consumed in the Stockholm
region and provides data from a comprehensive range of care pro-
viders, including primary, secondary, and hospital-based care. Thus,
these results are likely to be representative for all Sweden, and
extend findings from older and smaller studies in an important
way.19
There are some potential limitations to our study. First, the diagno-
sis of CHF was obtained from patient records through the administra-
tive registers and relies on the accuracy of the responsible physician.
However, most patients (83%) attended secondary or hospital care,
suggesting that the recorded diagnosis has been confirmed by a spe-
cialist and should be reliable. Procedures and recommendations for
establishing a diagnosis of CHF may have changed over the study
period from 2006 to 2010. However, the validity of the Swedish Na-
tional Patient Register, containing the same data for secondary care
and hospitalizations in our study, is high.22 Thus, a diagnosis of CHF
in the Swedish National Patient Register has a high validity (82%;
95% if primary diagnosis), and the validity for an acute myocardial in-
farction or stroke is even higher.30 – 32 Secondly, mortality was calcu-
lated from the moment of the first recorded diagnosis of CHF, which
may not always coincide with the actual onset of CHF, and hence
could have overestimated mortality. Also, we have no access to the
cause of death, and mortality was calculated as all-cause mortality.
Thirdly, we did not apply equally long run-in periods in our processing
of data from primary care regarding time trends in prevalence and
The epidemiology of heart failure in Sweden
Figure 4 Kaplan– Meier curves for 5-year survival rates, according to pre-existing co-morbidity, adjusted for age. IHD, ischaemic heart disease; AF,
atrial fibrillation/flutter; CVD, cerebrovascular disease; COPD, chronic obstructive pulmonary disease.
incidence. This may have underestimated the declining trends in
prevalence and incidence slightly. Finally, we did not assess the pos-
sible influence of the access to care and care giver organization, socio-
economic factors, and differences between urban and rural areas on
our results. These interesting questions, and the potential relation-
ship of drug treatment of CHF to outcome, are the subject of
further study.
In conclusion, our study suggests a 2.2% prevalence, 3.8/1000
person-years incidence, and 3.1/1000 person-years mortality of
CHF in Sweden. There is a decrease in the incidence and mortality
of CHF in both women and men, with no major change in prevalence
over time. Further studies to confirm these trends are warranted.
Acknowledgments
The authors acknowledge the expert statistical advice of Jamilette
Miranda Tellez. All authors have read and agree to the manuscript
as written.
Funding
The Stockholm County Council Drug and Therapeutics Committee; and
Karolinska Institutet.
Conflict of interest: none declared.
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