Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals

Abstract

Background: Large-scale and contemporary population-based studies of heart failure incidence are needed to inform resource planning and research prioritisation but current evidence is scarce. We aimed to assess temporal trends in incidence and prevalence of heart failure in a large general population cohort from the UK, between 2002 and 2014.

Methods: For this population-based study, we used linked primary and secondary electronic health records of 4 million individuals from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex. Eligible patients were aged 16 years and older, had contributed data between Jan 1, 2002, and Dec 31, 2014, had an acceptable record according to CPRD quality control, were approved for CPRD and Hospital Episodes Statistics linkage, and were registered with their general practice for at least 12 months. For patients with incident heart failure, we extracted the most recent measurement of baseline characteristics (within 2 years of diagnosis) from electronic health records, as well as information about comorbidities, socioeconomic status, ethnicity, and region. We calculated standardised rates by applying direct age and sex standardisation to the 2013 European Standard Population, and we inferred crude rates by applying year-specific, age-specific, and sex-specific incidence to UK census mid-year population estimates. We assumed no heart failure for patients aged 15 years or younger and report total incidence and prevalence for all ages (>0 years).

Findings: From 2002 to 2014, heart failure incidence (standardised by age and sex) decreased, similarly for men and women, by 7% (from 358 to 332 per 100 000 person-years; adjusted incidence ratio 0·93, 95% CI 0·91-0·94). However, the estimated absolute number of individuals with newly diagnosed heart failure in the UK increased by 12% (from 170 727 in 2002 to 190 798 in 2014), largely due to an increase in population size and age. The estimated absolute number of prevalent heart failure cases in the UK increased even more, by 23% (from 750 127 to 920 616). Over the study period, patient age and multi-morbidity at first presentation of heart failure increased (mean age 76·5 years [SD 12·0] to 77·0 years [12·9], adjusted difference 0·79 years, 95% CI 0·37-1·20; mean number of comorbidities 3·4 [SD 1·9] vs 5·4 [2·5]; adjusted difference 2·0, 95% CI 1·9-2·1). Socioeconomically deprived individuals were more likely to develop heart failure than were affluent individuals (incidence rate ratio 1·61, 95% CI 1·58-1·64), and did so earlier in life than those from the most affluent group (adjusted difference -3·51 years, 95% CI -3·77 to -3·25). From 2002 to 2014, the socioeconomic gradient in age at first presentation with heart failure widened. Socioeconomically deprived individuals also had more comorbidities, despite their younger age.

Interpretation: Despite a moderate decline in standardised incidence of heart failure, the burden of heart failure in the UK is increasing, and is now similar to the four most common causes of cancer combined. The observed socioeconomic disparities in disease incidence and age at onset within the same nation point to a potentially preventable nature of heart failure that still needs to be tackled.

Funding: British Heart Foundation and National Institute for Health Research.

Figure 1

Overall and age-stratified heart failure incidence in 2002 versus 2014 (A) Number of cases of incident heart failure per 100 000 people in the European Standard Population. (B) Estimated absolute number of cases of incident heart failure in the UK population (based on census mid-year estimates).

Figure 2

Temporal trends in comorbidities among patients diagnosed with incident heart failure, from 2002 to 2014 (A) Number of comorbidities, out of 17 major conditions, affecting patients with incident heart failure, over time. (B) Cumulative percentage of patients affected by individual comorbidities, over time. COPD=chronic obstructive pulmonary disease.

Figure 3

Temporal trends in heart failure incidence by socioeconomic status quintile (2002–14) Age and sex-standardised incidence per 100 000 people by year and socioeconomic quintile are presented with fitted local polynomial regression lines and 95% CIs in grey. Socioeconomic quintile refers to Index of Multiple Deprivation 2015 quintile.

Figure 4

Temporal trends in age at diagnosis of incident heart failure by socioeconomic status quintile (2002–14) Mean age at incident heart failure diagnosis by year and socioeconomic quintile is presented with fitted linear regression lines and 95% CIs in grey. Socioeconomic quintile refers to Index of Multiple Deprivation 2015 quintile.