Epidemiology, pathophysiology, and prognosis of heart failure in the elderly

Abstract

Heart failure (HF) represents the quintessential disorder of cardiovascular aging, reflecting the convergence of age-related changes in the cardiovascular system and other organ systems and the increasing prevalence of cardiovascular diseases at older age. The prevalence and incidence of HF increase progressively with advancing age, and HF imposes an enormous burden on society in mortality, morbidity, and associated health care costs. Despite major advances in treatment of HF over the last 25 years, the prognosis remains poor, with median survival rates of less than 5 years in older adults. As the population ages, it is anticipated that the number of older people with HF will increase dramatically over the next several decades.

Figure 1. Prevalence of Heart Failure in the United States by Age and Sex

Adapted from Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016;133(4):e38–360; with permission.

Figure 2. Association of Maximum Exercise Capacity with Age

Maximum exercise capacity usually begins to decline between the ages of 20 and 30 years and falls approximately 10% per decade. Exercise capacity is described in terms of ml O₂/kg/min. From Oxenham H, Sharpe N. Cardiovascular aging and heart failure. Eur J Heart Fail 2003;5(4):427–34; with permission.

Figure 3. Mortality within One Year of Hospitalization for Heart Failure by Age in the United States, 1999 to 2008

Data reflects the national population of Medicare fee-for-service beneficiaries in the United States. Mortality rates were calculated for one year from the date of admission. Data from Chen J, Normand SL, Wang Y, et al. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998–2008. JAMA 2011;306(15):1669–78.

Figure 4. Heart Failure Hospitalization Rates for Older Adults in the United States, 1998 to 2008

Data reflects the national population of Medicare fee-for-service beneficiaries in the United States. Hospitalization rates were calculated as the observed heart failure hospitalization rate per 100,000 person-years at risk among persons aged 65 to 74 years, 75 to 84 years, and 85+ years. Data from Chen J, Normand SL, Wang Y, et al. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998–2008. JAMA 2011;306(15):1669–78.

Figure 5. Distribution of Hospitalizations for Heart Failure by Age in the United States, 2000 and 2010

Data from National Center for Health Statistics, Data Brief No. 108, October, 2012.

Figure 6. Daily Risk of Readmission and Death Among Older Adults in the Year After Hospitalization for Heart Failure

Risk was calculated using hazard rates for the national population of older Medicare fee-for-service beneficiaries discharged after hospitalization for heart failure between 2008 and 2010. The risk of hospital readmission was calculated after incorporating the competing risk of death after hospital discharge. From Dharmarajan K. Comprehensive strategies to reduce readmissions in older patients with cardiovascular disease. Can J Cardiol 2016;32(11):1306–14; with permission.