Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Lars Køber, Rigshospitalet - Copenhagen University Hospital, Denmark,
- Second opponent: Professor Charlotte Björk Ingul, NTNU - Norwegian University of Science and Technology,
- Third member and chair of the evaluation committee: Professor Kåre Inge Birkeland, University of Oslo
Chair of the Defence
Professor II Henrik Schirmer, University of Oslo
Principal Supervisor
Professor Sigrun Halvorsen, University of Oslo
Summary
Heart failure (HF) is a clinical syndrome with symptoms and signs due to impaired cardiac pump function. It is declared a global pandemic affecting 1-2% of adults. Despite advancements in heart failure management the past decades, mortality remains high and exceeds most forms of serious cancers.
The studies of this thesis have investigated the Norwegian heart failure population by using nationwide health registries between 2008 and 2020. Firstly, we estimated the incidence rate, prevalence, and mortality of heart failure in Norway. Furthermore, we assessed how to estimate incidence from longitudinal health registries to minimize lookback bias. Finally, we investigated drug adherence and discontinuation of HF drugs in new-onset patients with HF. All studies were historical cohort studies.
We found that the prevalence of HF increased regardless of incidence rates due to the ageing of the population. Despite improved prognosis, mortality remained high. Furthermore, we found that incidence estimates of HF were more inflated with shorter lookback periods. A sufficient lookback period must be applied to minimize bias when assessing temporal trends in incidence rates from longitudinal registry data. Finally, we found low adherence and high discontinuation rates of HF drugs in Norway. 42% were adherent to dual HF therapy, while 5% were adherent to triple HF therapy. Nearly half the patients discontinued first-line treatment with beta-blockers or renin-angiotensin-system inhibitors within two years.
The results highlight that the prevalence of HF in Norway will continue to increase mainly due to the ageing of the population. Systematic efforts are needed to improve adherence to HF drugs in clinical practice. Our findings may aid clinicians, researchers, and decision-makers to plan, prioritize and allocate health care resources to ultimately improve patient outcomes in this vulnerable patient population.
Additional information
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