Heart Failure Risk Distribution and Trends in the United States Population, NHANES 1999-2016

Abstract

Background: Implementation of effective preventive interventions requires identification of high-risk individuals. We sought to define the distribution and trends of heart failure risk in the US population.

Methods: We calculated 10-year predicted heart failure risk among a representative sample of US adults aged 30-79 years, without baseline cardiovascular disease, from the National Health and Nutrition Examination Surveys (NHANES) 1999-2016. We used the published Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) model, which integrates demographic and risk factor data, to estimate 10-year heart failure risk. Participants were stratified by NHANES cycle, sex, age, and race/ethnicity and by 10-year heart failure risk, defined as low (<1%), intermediate (1% to <5%), and high (≥5%).

Results: From 1999-2000 to 2015-2016, mean predicted 10-year heart failure risk increased significantly from 2.0% to 3.0% (P < .05) in the population, most notably among non-Hispanic black (2.1% to 3.7%) and non-Hispanic white (2.4% to 3.6%) men. In 2013-2016, 17.6% of the studied population was at high predicted 10-year heart failure risk. The prevalence of high predicted heart failure risk was highest among non-Hispanic black men (23.1%), followed by non-Hispanic white men (19.2%) and non-Hispanic white women (17.9%).

Discussion: Mean population risk of heart failure increased significantly from 1999-2016. A substantial proportion of US adults are at high 10-year heart failure risk (≥5%), particularly non-Hispanic black men. These data underscore the importance of identifiying individuals at increased heart failure risk for targeted prevention measures to reduce the future burden of heart failure.

Keywords: Health disparities; Heart failure; Prevention; Risk stratification.

Figure 1:

Flow diagram depicting participant selection.

Figure 2.. Mean Predicted 10-year heart failure Risk among non-Hispanic Black, non-Hispanic White, and Hispanic Men (A) and Women (B) from the National Health and Nutrition Examination Survey 1999–2016.

This image demonstrates the trend in mean predicted 10-year risk of heart failure across NHANES cycles for each race-sex group. Note that the mean risk has generally increased for each group and black men consistently have had the highest mean risk.

Figure 3.. Stratification of Predicted 10-Year heart failure Risk* among non-Hispanic Black, non-Hispanic White, and Hispanic Men and Women from the National Health and Nutrition Examination Survey 2013–2016.

Caption: This figure shows the stratification of predicted 10-year risk of heart failure (low risk < 1%, intermediate risk 1% to <5%, and high risk ≥5%) for each sex and race/ethnicity group. Note that non-Hispanic black men have the highest proportion of high- and intermediate-risk individuals, and the smallest proportion of low-risk individuals.

Figure 4.. Distribution of Decile-specific Mean Predicted 10-year heart failure Risk among non-Hispanic Black, non-Hispanic White, and Hispanic Men (A) and Women (B) from the National Health and Nutrition Examination Survey 2013–2016.

This image demonstrates predicted 10-year risk for each decile of the non-Hispanic black, non-Hispanic white, and Hispanic populations. Note that non-Hispanic black men have the highest predicted 10-year heart failure risk at each decile, and among the highest risk decile non-Hispanic black men have a 10-year heart failure risk of 16.59%.