Links To And Excerpts From “Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America”

Posted on August 17, 2024 by Tom Wade MD

Today I review, link to and excerpt from Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. J Card Fail. 2023 Oct;29(10):1412-1451. doi: 10.1016/j.cardfail.2023.07.006. Epub 2023 Sep 26.

All that follows is from the above resource.

There is no abstract available.

1. Preamble

Trends in the epidemiology and outcomes for heart failure (HF) are critically important and have not been explicated and compiled in a comprehensive contemporary document. There have been concerning trends in the incidence, prevalence, mortality, and HF hospitalization rates over the past decade. Therefore, the specific goals of this document are:

  1. To establish a clear and comprehensive synthesis of trends in HF epidemiology and outcomes as a foundation for clinical care, resource allocation, and research.
  2. To address differences in HF epidemiology and outcomes according to sex, race, ethnicity, and age.
  3. To identify current knowledge gaps and limitations in HF epidemiologic data and to forecast the future impact and burden of HF.

 

The emphasis of the document is epidemiological trends in the United States (US), but when applicable, global trends are also included.

2. Incidence, Prevalence, and Lifetime Risk Estimates of HF in the United States

2.1. Summary

  • Approximately 6.7 million Americans over 20 years of age have HF, and the prevalence is expected to rise to 8.5 million Americans by 2030.
  • The lifetime risk of HF has increased to 24%; approximately 1 in 4 persons will develop HF in their lifetime.
  • The prevalence rate of HF among US adults is approximately 1.9% to 2.6% for the overall population and is higher among older patients. The prevalence rate is expected to increase to 8.5% among 65- to 70-year-olds.
  • The prevalence of HF with preserved ejection fraction (HFpEF) across populations is increasing, with significant differences by race and ethnicity, and men experience a higher lifetime risk HFpEF.
  • Approximately 33% of the US adult population without known symptomatic HF is at-risk for HF (Stage A HF) and 24%–34% have pre-HF (Stage B HF). The risk of developing HF in individuals with obesity and hypertension has increased.

2.2. Lifetime Risk of HF

In the Framingham Heart Study (FHS) cohort, the lifetime risk of HF increased to 23.7% during the second 25-year epoch (1990–2014) from 19.0% in the first 25-year epoch (1965–1989) (Fig. 1, Table 1).

During the second 25-year epoch (1990–2014), the lifetime risk of HFpEF (19.3%) was higher than HF with reduced ejection fraction (HFrEF) (11.4%). In the FHS Cohort, the lifetime risk of HF has risen across participants of both sexes (from 18.9% to 22.6% in women and from 19.1% to 25.3% in men). Similarly, the lifetime risk of HF in the Multi-Ethnic Study of Atherosclerosis (MESA) and Cardiovascular Health Study (CHS) cohort ranged from 23.8% in women to 27.4% in men and varied by race and ethnicity (Table 1; Fig. 2). Among HF sub-types, the lifetime risk of HFpEF was greater than the lifetime risk of HFrEF in women (10.7% vs 5.8%, respectively), whereas lifetime risk of HFpEF was similar to HFrEF in men (Fig. 2), but these vary by race and ethnicity.

The risk of developing HF in overweight or obese body mass index categories and participants with intermediate blood pressure (systolic blood pressure ≥130 but <140 mm Hg or diastolic blood pressure ≥80 but <90 mm Hg); and/or hypertension was 24%–62% higher during the second epoch (1990–2014) relative to corresponding risk factor strata in the first epoch (1965–1989).

The 10-year risk of HF, assessed via the Pooled Cohort Equations to Prevent Heart Failure among a representative sample of Americans from the National Health and Nutrition Examination Survey (NHANES), increased from 1.0% in 1999 to 3.0% in 2015.

2.3. Incidence of HF

The incidence of HF varies according to different populations and different time frames (Table 2). Differences in data sources, population demographics and composition (including age, comorbidities, sex, race, and ethnicity), HF ascertainment methodology, and periodic differences likely play a role in this variation. A decline in overall HF incidence has been reported in Medicare beneficiaries over the age of 65 from 35.7/1000 person-years (PY) to 6.5/1000 PY from 2011 to 2016 (Table 2). Olmsted County in Minnesota, with relatively homogeneous demographics, also demonstrated a declining incidence from 2000 to 2010 (Table 2). The 3-generational FHS population, which is predominantly composed of participants of White race, did not have a changing incidence from 1990 to 2009. On the other hand, a modest increased incidence of HF has been reported in the Atherosclerosis Risk in Communities (ARIC) cohort with populations intentionally selected from 4 different cohorts with more diverse demographic and geographic characteristics (Table 2). In the ARIC study, there was an initial focus on atherosclerosis and complications, and HF adjudication was slightly different from other studies. Some of the variations in the overall incidence and prevalence of HF across different studies can be explained by the variation of representation of HFpEF in different populations as it becomes the dominant phenotype. A trend for increasing prevalence of HFpEF was recognized across different populations. The rise in HFpEF prevalence can be attributed to increasing risk factors for HF, such as obesity and diabetes, but also to the difficulty of discrimination of HF from other causes of dyspnea and leg swelling in patients with obesity or large body habitus.

After age 45, HF incidence ranges from 6.0/1000 PY among the ARIC participants (between 1987 and 2005) to 7.9/1000 PY among the Chicago Heart Association Detection Project in Industry participants (between 1967 and 2003). After the index age of 65 years, the incidence is significantly higher, at 21.1/1000 PY as reported in the CHS participants (between 1989 and 2004).

2.4. Prevalence of HF

According to data from NHANES 2017–2020, approximately 6.7 million Americans over 20 years of age have HF, which has increased from former reports of 6.0 million (Fig. 3). HF prevalence progressively rises across each decade of life, with an up to 4-fold higher prevalence (8.0%–9.1%) among US adults older than 65 years compared with age less than 65. The overall prevalence of HF among US adults has ranged from 1.9% to 2.6% for the overall population based on self-reported data from NHANES (Table 3).

Based on self-report among participants of NHANES, the prevalence of HF for the overall population remained similar over time, from 31.8/1000 persons in 2001–2005 to 30.4/1000 persons in 2013–2016. However, among participants over the age of 65, the prevalence of HF has increased from 55/1000 persons in 1999 to 98/1000 persons in 2004 and declined to 64/1000 persons in 2017. By another report, among Medicare beneficiaries over the age of 65, the prevalence of HF assessed by claims-based diagnosis in the inpatient or outpatient setting increased from 162/1000 in 2004 to 172/1000 in 2013 (Table 3).

Among participants of the ARIC study above the age of 55, the age-adjusted prevalence of HF was higher among Black men (38.1/1000 PY) and Black women (30.5/1000 PY) vs White men (20.7/1000 PY) and White women (15.2/1000 PY) from 2005 to 2014. Prevalence of HF rose significantly (between 2% to 5% increase per year) across the study period. Prevalence of HF remains understudied in American Indian and Alaska Native populations (Table 3).

The article continues with much additional data on heart failure. [Full-Text PDF]

 

This entry was posted in Heart Failure, Heart Failure Society Of America. Bookmark the permalink.