Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 1;5(12):1425-1429.
doi: 10.1001/jamacardio.2020.3654.

Trends in the Prevalence of Self-reported Heart Failure by Race/Ethnicity and Age From 2001 to 2016

Leah Rethy  1 , Lucia C Petito  2 , Thanh Huyen T Vu  2 , Kiarri Kershaw  2 , Rupal Mehta  3 , Nilay S Shah  1 , Mercedes R Carnethon  2 , Clyde W Yancy  1   4 , Donald M Lloyd-Jones  1   2 , Sadiya S Khan  1   2
Affiliations

Trends in the Prevalence of Self-reported Heart Failure by Race/Ethnicity and Age From 2001 to 2016

Leah Rethy et al. JAMA Cardiol. .

Abstract

Importance: Despite recent advances in therapies for heart failure (HF), deaths from HF are increasing, with persistent disparities between Black and White adults. Recent national trends in the prevalence of HF need to be clarified to appropriately allocate resources and develop effective preventive interventions.

Objectives: To examine the prevalence of ambulatory HF overall and by race/ethnicity and age and the temporal changes in HF prevalence between 2001 and 2016.

Design, setting, and participants: This cross-sectional study of nationally representative data collected biennially through the National Health and Nutrition Examination Survey (NHANES) from January 1, 2001, to December 31, 2016, assessed nonpregnant adults 35 years and older who self-identified as non-Hispanic Black, non-Hispanic White, or Mexican American. Data analysis was performed from November 16, 2019, to April 12, 2020.

Exposures: Survey period, race/ethnicity, and age group.

Main outcomes and measures: Age-standardized prevalence was calculated within 4-year survey periods (2001-2004, 2005-2008, 2009-2012, and 2013-2016) based on self-report of ambulatory HF overall and by race/ethnicity and age group (35-64 and ≥65 years). Weighted multivariable logistic regression was used to examine trends in ambulatory HF prevalence over time by race/ethnicity and age group.

Results: A total of 26 097 participants (mean [SD] age, 55.9 [10.7] years; 13 192 [52%] female; 6519 [12%] non-Hispanic Black; and 4906 [7%] Mexican American) were studied. Overall age-standardized prevalence (per 100 000 population) of ambulatory HF was 3184 (95% CI, 2641-3728) from 2001 to 2005 and 3045 (95% CI, 2651-3438) from 2013 to 2016. The prevalence of ambulatory HF was highest among non-Hispanic Black adults: from 2013 to 2016, HF prevalence (per 100 000 population) was 5017 (95% CI, 3755-6279) among non-Hispanic Black adults, 2746 (95% CI, 2313-3179) among non-Hispanic White adults, and 2508 (95% CI, 1154-3862) among Mexican American adults. Differences between White and Black adults in HF prevalence were also present in younger and middle-aged adults (eg, 35-64 years of age in 2013-2016: 3864 [95% CI, 2369-5359] for non-Hispanic Black adults vs 1297 [95% CI, 878-1716] for non-Hispanic White adults).

Conclusions and relevance: This study found that a high burden of ambulatory HF persisted between 2001 and 2016 in the US. Disparities were most prominent by age group. Alongside prevention and aggressive management of risk factors, targeted efforts aimed at mitigating racial disparities are needed.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest Disclosures: Ms Rethy reported receiving grants from the Sarnoff Cardiovascular Research Foundation during the conduct of the study. Dr Mehta reported receiving grants from the National Institutes of Health during the conduct of the study, personal fees from Akebia/Otsuka, and stock ownership from Teva Pharmaceuticals, Abbott Laboratories, and AbbVie outside the submitted work. Dr Lloyd-Jones reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Khan reported receiving grants from the American Heart Association and the National Institutes of Health, National Center for Advancing Translational Sciences during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Overall Weighted Estimates of Prevalence of Heart Failure, 2001-2016
Trends in heart failure prevalence were not significant for crude (A) or age-standardized (B) prevalence of heart failure. Black solid and dashed lines represent the prevalence estimates and 95% CIs, respectively, for the overall sample. Solid lines and shaded areas represent heart failure prevalence estimates and 95% CIs, respectively, for racial/ethnic groups. Global P values for test for race interaction × time are as follows: logistic regression dummy P = .14, linear trend P = .26 (Wald test), and quadratic trend P = .51 (Wald test). NHANES indicates National Health and Nutrition Examination Survey.
Figure 2.
Figure 2.. Weighted Estimates of Prevalence of Heart Failure Stratified by Age Group, 2001-2016
Trends in heart failure prevalence in younger (35-64 years of age) adults (A) and older (65 years or older) adults (B) were not significant overall and when stratified by race/ethnicity. Black solid and dashed lines represent prevalence estimates and 95% CIs, respectively, for the overall sample. Solid lines and shaded areas represent heart failure prevalence estimates and 95% CIs, respectively, for racial/ethnic groups. Global P values for test for age interaction × time are as follows: logistic regression (dummy) P = .75, linear trend P = .37 (Wald test), and quadratic trend P = .61 Wald test). Global P values for test for race and age interaction × time are as follows: logistic regression (dummy) P = .33, linear trend P = .29 (Wald test), and quadratic trend P = .68 (Wald test). NHANES indicates National Health and Nutrition Examination Survey.
See this image and copyright information in PMC

References

    1. Virani SS, Alonso A, Benjamin EJ, et al. ; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee . Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-e596. doi:10.1161/CIR.0000000000000757 - DOI - PubMed
    1. Heidenreich PA, Albert NM, Allen LA, et al. ; American Heart Association Advocacy Coordinating Committee; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Stroke Council . Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606-619. doi:10.1161/HHF.0b013e318291329a - DOI - PMC - PubMed
    1. Chang PP, Wruck LM, Shahar E, et al. . Trends in hospitalizations and survival of acute decompensated heart failure in four US communities (2005-2014): ARIC study community surveillance. Circulation. 2018;138(1):12-24. doi:10.1161/CIRCULATIONAHA.117.027551 - DOI - PMC - PubMed
    1. Gerber Y, Weston SA, Redfield MM, et al. . A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med. 2015;175(6):996-1004. doi:10.1001/jamainternmed.2015.0924 - DOI - PMC - PubMed
    1. Glynn P, Lloyd-Jones DM, Feinstein MJ, Carnethon M, Khan SS. Disparities in cardiovascular mortality related to heart failure in the United States. J Am Coll Cardiol. 2019;73(18):2354-2355. doi:10.1016/j.jacc.2019.02.042 - DOI - PubMed

Publication types