(Circulation. 1999;100:280-286.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Seasonal Variation in Chronic Heart Failure Hospitalizations and Mortality in France
From the Department of Public Health and Medical Information, Nice Teaching Hospital, and the Department of Cardiology, Nice Teaching Hospital (P.G.), Nice, France.
Correspondence to Dr Fabrice Boulay, Département d'Information Médicale, CHU de Nice BP 1179, 06003 Nice Cedex 1, France. E-mail boulayf{at}hotmail.com
Background—Circannual variation in blood pressure and in the incidence of acute myocardial infarction is well known but has not been investigated in chronic heart failure. This report describes and compares the seasonal variation of chronic heart failure hospitalizations and mortality in the French population.
Methods and Results—All deaths that occurred among French adults
over the period 1992 to 1996 (n=138 602) and all discharges by adults
in French public hospitals for chronic heart failure over the period
1995 to 1997 (n=324 013) were examined retrospectively. First, chronic
heart failure deaths in France occurred with a striking annual
periodicity and peaked in winter (December through January), both in
the overall population and in subgroups defined by age (>44 years old)
and sex. The distribution of cumulative monthly deaths differed by
nearly 35%, ranging from a peak of 20% above average in January to
15% below average in August (Roger's test: P<0.001).
Second, hospitalizations for chronic heart failure in French public
hospitals followed a similar seasonal pattern
(P<0.001), with a winter-spring predominance (+7% to
+10% from December through April). Third, for persons 
85 years old,
excess hospitalizations occurred earlier in the year, with marked
synchronized peaks in January for both mortality and hospitalizations
(P<0.001).
Conclusions—Clear seasonal variations in adult chronic heart failure hospitalizations and deaths were identified. The considerable economic impact on health care services warrants further epidemiological investigations and a more comprehensive approach to disease management.
Key Words: heart failure • seasons • mortality
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