Trends in Heart Failure–Related Mortality Among Older Adults in the United States From 1999-2019

Siddiqi, Tariq Jamal; Minhas, Abdul Mannan Khan; Greene, Stephen J.; Spall, Harriette G.C. Van; Khan, Sadiya S.; Mentz, Robert J; Fonarow, Gregg C.; Butler, Javed; Khan, Muhammad Shahzeb

doi:10.1016/j.jchf.2022.06.012

Cited by 35 publications

(27 citation statements)

References 25 publications

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“…Despite improvements in treatment strategies and mortality rates for heart failure (HF), prevalence remains high, and some studies suggest a rising incidence among younger adults in the United States 1–5 . Potential contributing factors to ongoing high rates of HF hospitalization include an ageing population, rising rates of comorbidities, including cardiovascular risk factors such as hypertension, dyslipidaemia, and diabetes mellitus, and other population‐level changes in sociodemographic, lifestyle, or cardiometabolic profiles 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Differences in predictors of incident heart failure according to atherosclerotic cardiovascular disease status

Dawson,

Carrington,

Haregu

et al. 2023

ESC Heart Failure

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AimsHeart failure (HF) is a common cause of morbidity and mortality, related to a broad range of sociodemographic, lifestyle, cardiometabolic, and comorbidity risk factors, which may differ according to the presence of atherosclerotic cardiovascular disease (ASCVD). We assessed the association between incident HF with baseline status across these domains, overall and separated according to ASCVD status.Methods and resultsWe included 5758 participants from the Baker Biobank cohort without HF at baseline enrolled between January 2000 and December 2011. The primary endpoint was incident HF, defined as hospital admission or HF‐related death, determined through linkage with state‐wide administrative databases (median follow‐up 12.2 years). Regression models were fitted adjusted for sociodemographic variables, alcohol intake, smoking status, measures of adiposity, cardiometabolic profile measures, and individual comorbidities. During 65 987 person‐years (median age 59 years, 38% women), incident HF occurred among 784 participants (13.6%) overall. Rates of incident HF were higher among patients with ASCVD (624/1929, 32.4%) compared with those without ASCVD (160/3829, 4.2%). Incident HF was associated with age, socio‐economic status, alcohol intake, smoking status, body mass index (BMI), waist circumference, waist–hip ratio, systolic blood pressure (SBP), and low‐ and high‐density lipoprotein cholesterol (LDL‐C and HDL‐C), with non‐linear relationships observed for age, alcohol intake, BMI, waist circumference, waist–hip ratio, SBP, LDL‐C, and HDL‐C. Risk factors for incident HF were largely consistent regardless of ASCVD status, although diabetes status had a greater association with incident HF among patients without ASCVD.ConclusionsIncident HF is associated with a broad range of baseline sociodemographic, lifestyle, cardiometabolic, and comorbidity factors, which are mostly consistent regardless of ASCVD status. These data could be useful in efforts towards developing risk prediction models that can be used in patients with ASCVD.

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Section: Introductionmentioning

confidence: 99%

Differences in predictors of incident heart failure according to atherosclerotic cardiovascular disease status

Dawson,

Carrington,

Haregu

et al. 2023

ESC Heart Failure

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“…4 It is estimated that senior folks will make up 20% of the American population in 2030, and 57% of them are predicted to have HF, making them the group most at risk of dying from HF. 4 Among low-and middle-income countries, China has the highest burden of HF, with over 500 000 new cases diagnosed each year. 5,6 Despite the rising prevalence and significance of HF in China, there is still a dearth of accurate data on these patients, particularly the elderly over the age of 75 years.…”

Section: Introductionmentioning

confidence: 99%

“…Heart failure (HF) is a major problem in health care that affects public health globally 1–3 . As the global population ages, the burden of HF also rises 4 . It is estimated that senior folks will make up 20% of the American population in 2030, and 57% of them are predicted to have HF, making them the group most at risk of dying from HF 4 .…”

Section: Introductionmentioning

confidence: 99%

“…Despite the rising prevalence and significance of HF in China, there is still a dearth of accurate data on these patients, particularly the elderly over the age of 75 years. Although the proportion of patients aged ≥75 years is rising in the real world, they are typically underrepresented in clinical studies 4 . Differences in treatment options, therapeutic effects, pathophysiology and risk factors may exist in the elderly, and these variances may lead to radically different clinical outcomes 2 …”

Section: Introductionmentioning

confidence: 99%

“…Although the proportion of patients aged ≥75 years is rising in the real world, they are typically underrepresented in clinical studies. 4 Differences in treatment options, therapeutic effects, pathophysiology and risk factors may exist in the elderly, and these variances may lead to radically different clinical outcomes. 2 Age-related effects on outcome have practically become a standard in statistical models due to the centrality and significance of age in disease prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Impact of age on characteristics, performance measures and outcomes of inpatients for heart failure in Beijing, China

Yuan,

He,

et al. 2023

ESC Heart Failure

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AimsThis study aims to provide representative information on heart failure (HF) patients in China, especially older adults aged ≥75 years. We aim to clarify the age‐related discrepancies in performance measures and the modifying effect of age on the impact of HF patients' characteristics on clinical outcomes.Methods and resultsAll HF patients admitted into five tertiary and four secondary hospitals of the Capital Medical University were divided into two groups according to age: 1419 (53.3%) were <75 years, and 1244 (46.7%) were ≥75 years. Older HF patients were more likely to be women, with higher left ventricular ejection fraction, with co‐morbidities including chronic obstructive pulmonary disease/asthma, anaemia, chronic kidney disease, stroke/transient ischemic attack (TIA), atrial fibrillation/atrial flutter, hypertension, and coronary artery disease, while obesity, diabetes mellitus, hypercholesterolaemia and valvular heart disease were more prevalent among younger HF patients. Left ventricular ejection fraction assessment was performed in a similar proportion of patients in the younger and older groups (81.7% vs. 80.5%, P = 0.426), while B‐type natriuretic peptide/N terminal pro brain natriuretic peptide was tested in a lower proportion in the younger group (84.8% vs. 89%, P = 0.001). At discharge, HF with reduced ejection fraction patients were less likely to receive beta‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers, or combined beta‐blockers and angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers therapy in the older group (49.74% vs. 63.2%, P = 0.002; 52.9% vs. 64.7%, P = 0.006; and 28.57% vs. 45.5%, P < 0.001, respectively) but were equally likely to receive mineralocorticoid receptor antagonists in the two age groups (80.8% vs. 84.1%, P = 0.322). Older patients with HF had higher risk of in‐hospital and 1 year mortality (2.7% vs. 1.3%, P = 0.011; 21.7% vs. 12.5%; P < 0.001, respectively). Higher body mass index was associated with better outcomes in both age groups. New York Heart Association functional class IV and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were independent predictors of 1 year mortality. The associations between patients' characteristics and risk of mortality were not modified by age.ConclusionsHF patients aged ≥75 years had distinct clinical profiles, received worse in‐hospital therapies and experienced higher in‐hospital and 1 year mortality.

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Trends in Mortality After Incident Hospitalization for Heart Failure Among Medicare Beneficiaries

Vohra,

Moghtaderi,

Luo

et al. 2024

JAMA Netw Open

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ImportanceDespite advances in treatment and care quality for patients hospitalized with heart failure (HF), minimal improvement in mortality has been observed after HF hospitalization since 2010.ObjectiveTo evaluate trends in mortality rates across specific intervals after hospitalization.Design, Setting, and ParticipantsThis cohort study evaluated a random sample of Medicare fee-for-service beneficiaries with incident HF hospitalization from January 1, 2008, to December 31, 2018. Data were analyzed from February 2023 to May 2024.Main Outcomes and MeasuresUnadjusted mortality rates were calculated by dividing the number of all-cause deaths by the number of patients with incident HF hospitalization for the following periods: in-hospital, 30 days (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), intermediate term (1-2 years after discharge), and long term (2-3 years after discharge). Each period was considered separately (ie, patients who died during one period were not counted in subsequent periods). Annual unadjusted and risk-adjusted mortality ratios were calculated (using logistic regression to account for differences in patient characteristics), defined as observed mortality divided by expected mortality based on 2008 rates.ResultsA total of 1 256 041 patients (mean [SD] age, 83.0 [7.6] years; 56.0% female; 86.0% White) were hospitalized with incident HF. There was a substantial decrease in the mortality ratio for the in-hospital period (unadjusted ratio, 0.77; 95% CI, 0.67-0.77; risk-adjusted ratio, 0.74; 95% CI, 0.71-0.76). For subsequent periods, mortality ratios increased through 2013 and then decreased through 2018, resulting in no reductions in unadjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.94; 95% CI, 0.82-1.06; short-term mortality ratio, 1.02; 95% CI, 0.87-1.17; intermediate-term mortality ratio, 0.99; 95% CI, 0.79-1.19; and long-term mortality ratio, 0.96; 95% CI, 0.76-1.16) and small reductions in risk-adjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.88; 95% CI, 0.86-0.90; short-term mortality ratio, 0.94; 95% CI, 0.94-0.95; intermediate-term mortality ratio, 0.94; 95% CI, 0.92-0.95; and long-term mortality ratio, 0.95; 95% CI, 0.93-0.96).Conclusions and RelevanceIn this study of Medicare fee-for-service beneficiaries, there was a substantial decrease in in-hospital mortality for patients hospitalized with incident HF from 2008 to 2018, but little to no reduction in mortality for subsequent periods up to 3 years after hospitalization. These results suggest opportunities to improve longitudinal outpatient care for patients with HF after hospital discharge.

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Trends in Heart Failure–Related Mortality Among Older Adults in the United States From 1999-2019

Cited by 35 publications

References 25 publications

Differences in predictors of incident heart failure according to atherosclerotic cardiovascular disease status

Differences in predictors of incident heart failure according to atherosclerotic cardiovascular disease status

Impact of age on characteristics, performance measures and outcomes of inpatients for heart failure in Beijing, China

Trends in Mortality After Incident Hospitalization for Heart Failure Among Medicare Beneficiaries

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