Key Points By Category
- Approximately 6.7 million Americans over 20 years of age have HF, and the prevalence is expected to rise to 8.5 million Americans by 2030.
- The lifetime risk of HF has increased to 24%, approximately 1 in 4 persons will develop HF in their lifetime.
- The prevalence rate of HF among US adults is approximately 1.9% to 2.6% for the overall population and is higher among older patients. The prevalence rate is expected to increase to 8.5% among 65 to 70-year-olds.
- The prevalence of heart failure with preserved ejection fraction (HFpEF) across populations is increasing, with significant differences by race and ethnicity, and women experience a higher lifetime risk HFpEF.
- Approximately 33% of the US adult population without known symptomatic HF is at-risk for HF (Stage A HF) and 24-34% have pre-HF (Stage B HF). The risk of developing HF in individuals with obesity and hypertension has increased.
- Overall HF prevalence is increasing globally, but HF incidence, prevalence, etiology, and outcomes vary across different regions around the globe.
- HF prevalence estimates around the world range from 1% to 3% of the overall population.
- The prevalence of risk factors for HF including hypertension, obesity, and smoking are increasing globally over time. The proportion of individuals with HF exhibiting 3 or more comorbidities increased from 68% in 2002-2004 to 87% in 2012-2014.
- Disparities in social determinants of health (SDoH) and health inequities are important HF risk factors and result in increased mortality and other adverse outcomes in individuals at risk for HF or with HF.
- The incidence and prevalence of HF is higher among Black individuals compared with other racial and ethnic groups. The prevalence of HF has increased among Black and Hispanic individuals over time.
- The prevalence of HF is higher among young and middle-aged Black adults compared with young and middle-aged White adults.
- In the overall population, HF is most prevalent among adults greater than 60 years old.
- There are important sex differences in HF risk factors. Diabetes mellitus, hypertension, and tobacco use have a stronger association with HF in women, while CHD has a stronger association with HF in men.
- The global number of HF cases has increased with more HF cases in women compared with men.
- HF mortality rates have been increasing since 2012.
- Age-adjusted HF mortality rates are highest for non-Hispanic Black individuals. Black, American Indian, and Alaska Native individuals with HF have the highest all-cause age-adjusted mortality compared with other racial and ethnic groups. From 2010 to 2020, HF mortality rates have increased for Black women and men at a rate faster than any other racial or ethnic group, particularly for individuals below the age of 65.
- Age-adjusted mortality rates (AAMRs) for HF have increased in the last decade with similar patterns of increase in women and men.
- A greater relative annual increase in HF-related mortality rates has been noted for younger (35–64 years) compared with older (65–84 years) adults.
- Rural areas demonstrate higher HF mortality rates for both younger and older age groups compared with urban areas.
- Rates of HF hospitalizations declined from 2010 to 2014, followed by an increase from 2014 to 2017.
- This increase was consistent across age groups and sexes, with the highest rates being Black patients.
- HF hospitalizations among young adults between the ages of 18–45 years also increased since 2013, and Black patients accounted for 50% of these hospitalizations.
- HF hospitalizations among the elderly (age >80 years) have increased since 2014 with high burdens of hospitalizations among patients with comorbid conditions.
- Within the US there are geographic variations in the prevalence of HF. A low HF prevalence has been reported in the northern Great Plains, and Western states, and the highest prevalence of HF has been reported in Midwestern and Eastern states.
- There is also significant geographic variation across the US in HF death rates, with the lowest rate of HF deaths reported in some Western, Northwestern, and Northeastern states and the highest death rates reported in some states in the Midwest and the Southeast.
- HF prevalence and HF mortality rates are not fully aligned geographically, which suggests a role of contributing factors such as underdiagnosis and access to treatment. Further, significant variation in HF mortality is seen within individual states by county.
- In addition, there are regional differences in the proportion of patients diagnosed with HFrEF and HFpEF, which likely relates to varied population demographics across the US, including age, racial and ethnic background, and comorbidity prevalence.
- Without guideline-directed medical therapy (GDMT), the 2-year mortality rate of patients with HFrEF is estimated at 35%. The magnitude of benefit of GDMT as demonstrated in randomized controlled trials.
- Current use of GDMT in patients with HFrEF remains suboptimal, with only a low percentage of patients being treated with all the indicated medical therapies at target or maximally tolerated doses.
- Although there have been increases in the use of advanced therapies including durable mechanical circulatory support and cardiac transplantation, and other recommended therapies such as structural interventions, the use of these therapies in indicated patients remains low.
- Although HF is associated with a significant health burden and is associated with adverse outcomes; large-scale population-based registries and outcome studies specifically targeting detection of populations at-risk for HF, pre-HF, HF, or advanced HF; specific etiologies of HF and cardiomyopathies; EF subgroups; according to race/ethnicity, sex, gender, geography, SDoH, and structural inequity are lacking.
- Existing data and population cohorts do not provide continuous information over time; as such, the authors have examined trends across multiple descriptive studies to be able to provide their high-level interpretation of changes over time. The authors recognize that the existing cohorts represent specific patient populations, and trends may be specific to particular geographic and age groups and may not be generalizable to other populations.
- The role of biomarkers, molecular markers, imaging, and genetic profiling is rapidly evolving, and will likely be incorporated at a greater scale in HF care for risk detection, diagnosis, determination of specific etiology, prognosis, and outcomes in HF.
- It is important to also recognize that existing coding guidelines fail to recognize HF as an underlying cause of death, but rather as a mediator between death and disease, requiring death attributable to other conditions (e.g., CHD, hyper-tension, cardiomyopathy). HF mortality is often redistributed to these causes and is therefore under-detected.
- These considerations underline the necessity of large-scale registries and research studies specifically addressing HF epidemiology, risk factors, and outcomes, and the importance of capturing HF as a primary underlying cause of death.
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Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America
Journal of Cardiac Failure
Published September 23, 2023
