A Contemporary Appraisal of the Heart Failure Epidemic in Olmsted County, Minnesota, 2000-2010

By Y. Gerber, S. Weston, M. Redfield, A. Chamberlain, S. Manemann, Ruoxiang Jiang, J. Killian, Véronique L. Roger. JAMA Internal Medicine, 2015

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IMPORTANCE Heart failure (HF) is commonly referred to as an epidemic posing major clinical and public health challenges. Yet, contemporary data on its magnitude and implications are scarce. OBJECTIVES To evaluate recent trends in HF incidence and outcomes, overall and by preserved (HFpEF) or reduced (HFrEF) ejection fraction. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Incidence rates of HF in Olmsted County, Minnesota (population ~140,000), from 2000-2010 were assessed. Patients identified with incident HF (n=2,762; mean age, 76 years; 43% male) were then followed up for all-cause and cause-specific hospitalizations (through December 2012) and death (through March 2014). RESULTS The age- and sex-adjusted incidence of HF declined substantially (annual percent change, −4.6), equating to a rate reduction of 37% (95% confidence interval (CI): −30% to −44%) over the last decade. The incidence declined for both HF types, but was greater (P for interaction=0.08) for HFrEF (−45%, 95% CI: −33% to −55%) than HFpEF (−28%; 95% CI: −13% to −40%). Mortality was high (24% and 54% for 60 and 80 year-olds at 5 years of follow-up, respectively), frequently ascribed to non-cardiovascular causes (54%), and did not decline over time. The risk of cardiovascular mortality was lower for HFpEF than HFrEF (multivariable-adjusted hazard ratio 0.76; 95% CI: 0.64-0.90), whereas that of non-cardiovascular mortality was similar (1.07; 95% CI: 0.85-1.33). Hospitalizations were common (mean, 1.34 per person-year; 95% CI: 1.25 to 1.44), particularly among men, and did not differ between HFpEF and HFrEF. The majority of hospitalizations (63%) were due to non-cardiovascular causes. Hospitalization rates for cardiovascular causes did not change over time, whereas those for non-cardiovascular causes increased. CONCLUSIONS AND RELEVANCE Over the last decade, the incidence of HF declined substantially, particularly for HFrEF, contrasting with no apparent change in mortality. Non-cardiovascular conditions play an increasing role in hospitalizations and remain the most frequent cause of death. This underscores the need to augment disease-centric management approaches with holistic strategies to reduce the population burden of HF.

Subfields: Cardiology and Cardiovascular Medicine

View Paper: https://www.semanticscholar.org/paper/020533616e29c440e2bccca79f770b74191fb9d5

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In Cardiology and Cardiovascular Medicine

  1. Véronique L. Roger
  2. M. Redfield
  3. Barry A. Borlaug

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