Context The epidemic of heart failure has yet to be fully investigated, and data on incidence, survival, and sex-specific temporal trends in community-based populations are limited. Objective To test the hypothesis that the incidence of heart failure has declined and survival after heart failure diagnosis has improved over time but that secular trends have diverged by sex. Design, Setting, and Participants Population-based cohort study using the resources of the Rochester Epidemiology Project conducted in Olmsted County, Minnesota. Patients were 4537 Olmsted County residents (57% women; mean [SD] age, 74 [14] years) with a diagnosis of heart failure between 1979 and 2000. Framingham criteria and clinical criteria were used to validate the diagnosis Main Outcome Measures Incidence of heart failure and survival after heart failure diagnosis. Results The incidence of heart failure was higher among men (378/100000 persons; 95% confidence interval [CI], 361-395 for men; 289/100000 persons; 95% CI, 277-300 for women) and did not change over time among men or women. After a mean follow-up of 4.2 years (range, 0-23.8 years), 3347 deaths occurred, including 1930 among women and 1417 among men. Survival after heart failure diagnosis was worse among men than women (relative risk, 1.33; 95% CI, 1.24-1.43) but overall improved over time (5-year age-adjusted survival, 43% in 1979-1984 vs 52% in 1996-2000, PϽ.001). However, men and younger persons experienced larger survival gains, contrasting with less or no improvement for women and elderly persons. Conclusion In this community-based cohort, the incidence of heart failure has not declined during 2 decades, but survival after onset of heart failure has increased overall, with less improvement among women and elderly persons.

In the community, more than half of patients with HF have preserved EF, and isolated diastolic dysfunction is present in more than 40% of cases. Ejection fraction and diastolic dysfunction are independently related to higher levels of BNP. Heart failure with preserved EF is associated with a high mortality rate, comparable to that of patients with reduced EF.

HF) is commonly referred to as an epidemic, posing major clinical and public health challenges. Yet, contemporary data on its magnitude and implications are scarce.OBJECTIVE To evaluate recent trends in HF incidence and outcomes overall and by preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF).

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Objective To determine the lifetime burden and risk factors for hospitalization after heart failure (HF) diagnosis in the community. Background Hospitalizations in patients with HF represent a major public health problem, however the cumulative burden of hospitalizations after HF diagnosis is unknown, and no consistent risk factors for hospitalization have been identified. Methods We validated a random sample of all incident HF cases in Olmsted County, Minnesota from 1987–2006 and evaluated all hospitalizations after HF diagnosis through 2007. International Classification of Diseases, 9th Revision codes were used to determine the primary reason for hospitalization. To account for repeated events, Andersen-Gill models were used to determine the predictors of hospitalization after HF diagnosis. Patients were censored at death or last follow-up. Results Among 1077 HF patients (mean age 76.8 years, 582 [54.0%] female), 4359 hospitalizations occurred over a mean follow-up of 4.7 years. Hospitalizations were common after HF diagnosis, with 895 (83.1%) patients hospitalized at least once, and 721 (66.9%), 577 (53.6%) and 459 (42.6%) hospitalized ≥2, ≥3, and ≥4 times, respectively. The reason for hospitalization was HF in 713 (16.5%) hospitalizations, other cardiovascular in 936 (21.6%), while over half (n=2679, 61.9%) were non-cardiovascular. Male sex, diabetes mellitus, chronic obstructive pulmonary disease, anemia, and creatinine clearance <30 mL/min were independent predictors of hospitalization (p<0.05 for each). Conclusions Multiple hospitalizations are common after HF diagnosis, though less than half are due to cardiovascular causes. Comorbid conditions are strongly associated with hospitalizations, information that could be used to define effective interventions to prevent hospitalizations in HF patients.