Epidemiology and risk profile of heart failure

Abstract

Heart failure (HF) is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five. Although promising evidence shows that the age-adjusted incidence of HF may have plateaued, HF still carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. HF represents a considerable burden to the health-care system, responsible for costs of more than $39 billion annually in the USA alone, and high rates of hospitalizations, readmissions, and outpatient visits. HF is not a single entity, but a clinical syndrome that may have different characteristics depending on age, sex, race or ethnicity, left ventricular ejection fraction (LVEF) status, and HF etiology. Furthermore, pathophysiological differences are observed among patients diagnosed with HF and reduced LVEF compared with HF and preserved LVEF, which are beginning to be better appreciated in epidemiological studies. A number of risk factors, such as ischemic heart disease, hypertension, smoking, obesity, and diabetes, among others, have been identified that both predict the incidence of HF as well as its severity. In this Review, we discuss key features of the epidemiology and risk profile of HF.

Figure 1

Prevalence of heart failure by age and sex in the USA. Based on the National Health and Nutrition Examination Survey, 2003–2006. With permission from Lloyd-Jones, D. et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 121, e46–e215 (2010).

Figure 2

Age-adjusted survival after the onset of heart failure in a | men and b | women over time, from 1950 to 1999, based on the Framingham Heart Study. Estimates shown are for patients aged 65 to 74 years. Reproduced with permission from Levy, D. et al. Long-term trends in the incidence of and survival with heart failure. N. Engl. J. Med. 347, 1397–1402 © 2002 Massachusetts Medical Society. All rights reserved.

Figure 3

Survival after incident heart failure hospitalization by race and sex, based on the ARIC (Atherosclerosis Risk in Communities) Study, 1987–2002. Reprinted from Am. J. Cardiol. 101, Loehr, L. R. et al. Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study), 1016–1022 © 2008, with permission from Elsevier.

Figure 4

Time trends of age-adjusted hospitalization rates in men and women, based on the National Hospital Discharge Survey, 1979–2004. Trends shown for heart failure as the first-listed or additional (2^nd to 7^th) diagnosis for men and women. Reprinted from J. Am. Coll. Cardiol. 52, Fang, J. et al. Heart failure-related hospitalization in the U.S., 1979 to 2004, 428–434 © 2008, with permission from Elsevier.