A randomised controlled trial to determine the effect on response of including a lottery incentive in health surveys [ISRCTN32203485]

BACKGROUND: Postal questionnaires are an economical and simple method of data collection for research purposes but are subject to non-response bias. Several studies have explored the effect of monetary and non-monetary incentives on response. Recent meta-analyses conclude that financial incentives are an effective way of increasing response rates. However, large surveys rarely have the resources to reward individual participants. Three previous papers report on the effectiveness of lottery incentives with contradictory results. This study aimed to determine the effect of including a lottery-style incentive on response rates to a postal health survey. METHODS: Randomised controlled trial. Setting: North and West Birmingham. 8,645 patients aged 18 or over randomly selected from registers of eight general practices (family physician practices). Intervention: Inclusion of a flyer and letter with a health questionnaire informing patients that returned questionnaires would be entered into a lottery-style draw for £100 of gift vouchers. Control: Health questionnaire accompanied only by standard letter of explanation. Main outcome measures: Response rate and completion rate to questionnaire. RESULTS: 5,209 individuals responded with identical rates in both groups (62.1%). Practice, patient age, sex and Townsend score (a postcode based deprivation measure) were identified as predictive of response, with higher response related to older age, being female and living in an area with a lower Townsend score (less deprived). CONCLUSION: This RCT, using a large community based sample, found that the offer of entry into a lottery style draw for £100 of High Street vouchers has no effect on response rates to a postal health questionnaire

Ten-year prognosis of heart failure in the community: follow-up data from the Echocardiographic Heart of England Screening (ECHOES) study.

AIMS: This study investigates the 10-year survival in the ECHOES (Echocardiographic Heart of England Screening) study and examines factors associated with prognosis. METHODS AND RESULTS: A prospective study was carried out to investigate 10-year survival in those with heart failure (HF) and/or left ventricular systolic dysfunction (LVSD). The mean age of participants in ECHOES was 64, and 50% were male. Records of all 6162 screened participants were flagged, and deaths up to 25 February 2009 were coded. Causes of death were categorized according to diagnosis on death certificate. Kaplan-Meier curves and log rank tests were used to compare survival times of participants with HF and LVSD in different diagnostic groups. A Cox proportional hazards regression model was used to identify variables associated with risk of death. A total of 2062 of the 6162 (33.5%) participants had died at the census date in February 2009. Of these deaths, 902 (43.7%) were due to cardiovascular disease, including 263 (12.8%) due to HF. Ten-year survival was 75% for participants without HF, 26.7% for those with HF, 37.6% for those with LVSD, and 27.4% for those with HF and LVSD. Multiple-cause HF had a 10-year survival of 11.6%. Multiple variables including diabetes, valvular disease, diuretic use, and a previous label of HF, as well as lifestyle factors such as smoking and obesity, were associated with increased risk of death. CONCLUSIONS: Patients with HF and LVSD have a poor prognosis. However, the mortality rates of all-cause, all-stage HF as measured in the ECHOES cohort are around half those reported for patients diagnosed for the first time with HF during hospital admission

Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis protocol

Abstract Background Heart failure (HF) is a common condition affecting more than 10% of those over 70 years of age. Reliable estimates of survival following a diagnosis of HF are important to guide management and facilitate advanced care planning. Most existing research has focused on survival rates for patients admitted to hospital with acute HF. However, the majority of patients with HF are diagnosed in the outpatient setting and can have periods of sustained symptom stability in the chronic phase of their illness. There has not been a systematic review of the literature to determine the prognosis of patients with chronic HF in the community. Methods We will undertake a comprehensive search of the following databases: CINAHL, Database of Abstracts of Reviews of Effects, Embase, MEDLINE and the Clinical Trials Register (clinicaltrials.gov). Two reviewers will independently complete screening, data extraction and quality appraisal with the option of input from a third reviewer to arbitrate. We will include data from observational or database studies conducted in either community or outpatient settings. Studies of acute HF or specific subgroups of patients will be excluded. There is no restriction by geographical setting, publication language or study date. We will complete QUIPS and GRADE assessments to systematically appraise the quality of evidence within and between studies. Where possible, we will seek to pool results to conduct a meta-analysis and undertake relevant subgroup analysis including by study setting, participant age and study decade. The primary outcome will be survival time from diagnosis. The secondary outcomes will be HF-related hospital admissions, symptom burden and measures of morbidity. Discussion This systematic review will provide up to date evidence on the current survival rates and prognostic indicators for patients with chronic HF. We will put this into historical perspective, comparing outcomes across time to help understand the impact of advances in evidence-based treatment on average survival. This information is important in facilitating informed decision-making for patients and health professionals as well as highlighting areas to focus resources and improve public health planning. Systematic review registration PROSPERO 2017 CRD4201707568

Survival of patients with chronic heart failure in the community: a systematic review and meta‐analysis

Aim: To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting. Methods and results: We searched in relevant databases from inception to August 2018 for non‐interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta‐analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3–96.9), 86.5% (85.4–87.6), 72.6% (67.0–76.6), 56.7% (54.0–59.4) and 34.9% (24.0–46.8), respectively. The 5‐year survival rates improved between 1970–1979 and 2000–2009 across healthcare settings, from 29.1% (25.5–32.7) to 59.7% (54.7–64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co‐morbidities, and treatment rates. Conclusion: These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence‐based treatments. Further research exploring the barriers and facilitators to treatment is recommended. </p

Community prevalence of left ventricular dysfunction and atrial fibrillation, and impact on quality of life

Heart failure is common and causes high mortality and morbidity. ACE inhibitors significantly improve prognosis in left ventricular (LV) systolic dysfunction, so accurate diagnosis is important Atrial fibrillation (AF) is also common and anticoagulation reduces embolic stroke risk Prevalence data will help identify those at highest risk with a view to screening Little is known of overall quality of life in cardiac conditions Methods: The prevalence of LV systolic dysfunction and AF was assessed in the community, in 3960 patients aged 45+ (63% response). All had clinical history and examination, ECG, echocardiography, and the SF-36 health status questionnaire Further cohorts of 782 with a diagnosis of heart failure, 928 on diuretics, and 1062 with risk factors (MI, angina, hypertension, diabetes) were assessed similarly Results: The prevalence of significant left ventricular dysfunction (ejection fraction (EF) &lt;40%) was 1 8%, 3.5% had borderline LV function (EF 40-50%) Prevalence of EF &lt;40% increased from 0.3% in 45-54 year olds to 3 7% at 75-84 years 99% of the patients had some ECG abnormality 47% of those with EF &lt;40% were asymptomatic 32% of those with symptomatic LV dysfunction took ACE inhibitors Only 22% of patients with a previous clinical diagnosis of heart failure had EF &lt;40% 18% had evidence of valvular disease and 22 5% were in AF, half of those in AF had EF &gt;50%. Less than 10% of patients on diuretics had EF &lt;40% 22% of those in the community with a previous MI had EF &lt;40%, with EF 40-50% in a further 20%, 8.1% of patients with angina, 6.3% of diabetics and 1.8% of hypertensives had EF &lt;40%. The prevalence of AF in the general population was 20%, prevalence rising with age to 8% over the age of 75 About 5% of patients with ischaemic heart disease, hypertension or diabetes had concomitant AF Patients with heart failure had significant impairment of all measured areas of health All modalities of health were affected in ordered sequence with NYHA class Those with asymptomatic LV dysfunction had similar health perceptions to the random population sample Those with heart failure had more impairment of all the measured areas of health, except pain, than those with other cardiovascular conditions Conclusions: LV dysfunction is found frequently in those with ischaemic heart disease and AF is very common in the elderly Screening such patients would yield many candidates for treatment Heart failure has great impact on overall quality of life. The rapidly-assessed NYHA class of patients was a good predictor of patients' overall quality of life

Prognosis of all-cause heart failure and borderline left ventricular systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES).

AIMS: Heart failure (HF) is reported to have an essentially malignant prognosis that can be modified by several interventions. Most outcome data on HF are available from randomized controlled treatment trials and longitudinal epidemiological studies. However, for a number of reasons, neither type of study have, to date, provided generalizable data on HF mortality. Furthermore, data on the prognosis of borderline left ventricular systolic dysfunction (LVSD) are even more limited. METHODS AND RESULTS: ECHOES (Echocardiographic Heart of England Screening Study) screened a total of 6,162 patients from a total of 10,161 invited (61% response rate). Patients were randomly selected from four pre-specified cohorts: the general population, diuretic users, those with a prior clinical label of HF, and a population with risk factors for HF, to identify the prevalence of HF and LVSD based on clinical assessment, ECG, and echocardiography. Causes of death during a 5-9 year follow-up period were recorded from routine mortality statistics. The 5-year survival rate of the general population was 93%, compared with 69% of those with LVSD without HF, 62% with HF and no LVSD, and 53% with HF plus LVSD. Survival improved significantly with increasing ejection fraction (EF) (log rank test for trend, chi(2) = 534.5, 1, P &lt; 0.0001). CONCLUSION: The ECHOES mortality data confirm the poor prognosis of patients suffering prevalent HF across the community with a mortality risk estimate of 9% per year. Borderline systolic dysfunction (EF 40-50%) on echocardiography carries a poor prognosis

Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis protocol

Aim: To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting. Methods and results: We searched in relevant databases from inception to August 2018 for non‐interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta‐analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3–96.9), 86.5% (85.4–87.6), 72.6% (67.0–76.6), 56.7% (54.0–59.4) and 34.9% (24.0–46.8), respectively. The 5‐year survival rates improved between 1970–1979 and 2000–2009 across healthcare settings, from 29.1% (25.5–32.7) to 59.7% (54.7–64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co‐morbidities, and treatment rates. Conclusion: These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence‐based treatments. Further research exploring the barriers and facilitators to treatment is recommended. </p