Contributor: Chris Sobowale

Over 6.5 million Americans have HF, costing over $31 billion annually. Those are big numbers, but what is the trend? Berry et al explored the epidemiology of heart failure by examining fee-for-service Medicare patients from 2002-2013. This was presented as a late-breaker at the AHA Scientific Sessions 2017 with simultaneous publication in Circulation: Heart Failure – the new editor teams’ first simultaneous publication – but hopefully not our last!

Comparing the 1970s to the 1990s, HF has changed dramatically. Increasing incidence reflects an aging population and improved survival in patients with atherosclerotic disease. HF incidence stabilized in the mid-1990s and then declined by the early 2000s. This study cohort showed HF incidence declined 32% during the study period (2004-2013). Good news, right? Not so fast. The prevalence of heart failure increased almost 6% during the study period, across all demographics and geographic subgroups (Figure 1).

This randomly selected analysis samples 5% of the Center for Medicare and Medicaid Services data set. These patients were >65 years of age with at least 1 year of continuous enrollment in both Medicare Part A (inpatient) and Part B (outpatient).

Trends from 2004-2013:

  • Decreased HF incidence across all age groups. The greatest decline (24%) occurred in the oldest age group (>85 years of age).
  • Self-reported black patients had the highest rates of new HF diagnosis, followed by Hispanics, whites, then Asians.
    The Western portion of the US had significantly lower incidence of HF compared to the Northeast, Midwest and South.
  • Risk-adjusted mortality in patients within 1 year after diagnosis of heart failure improved from 25.7% to 23.0% (with a more pronounced decline among inpatients).

Highlight: This study included both outpatient and inpatient diagnoses of heart failure, whereas most studies focus solely on inpatient heart failure incidence.

Let’s talk limitations. Identification of HF was by ICD-9 codes and diagnosis was not verified by chart review. HF subtypes were not provided, HFrEF vs. HFpEF or ischemic vs. non-ischemic. Lastly, only Medicare patients over 65 years old were included.

In a heartbeat… Despite decreased incidence, the prevalence of HF is markedly increasing, creating an increased burden overall. This suggests people are living longer with heart failure. Given this, more resources should be allocated to the aging HF population with the need for more advanced therapies.

Study Link: Contemporary Epidemiology of Heart Failure in Fee-For-Service Medicare Beneficiaries Across Healthcare Settings