麻豆传媒

Heart failure rates dropped dramatically between 2000 and 2010, but hospitalizations among heart failure patients did not decline in a population-based study from Olmsted County, Minn.

Age- and sex-adjusted heart failure incidence dropped by 37.5% during the decade, with 315.8 heart failure cases per 100,000 people in 2000 and 219.3 cases per 100,000 in 2010 (annual percentage change, -4.6%), researcher and colleagues from the Mayo Clinic, Rochester, Minn., wrote online in .

The steepest declines were seen in heart failure cases with reduced (<50%) ejection fraction (HFrEF), with a 45.1% drop over the 10-year period (95% CI -33.0% to -55%), compared with a 27.9% drop (95% CI -12.9% to -40.3%) in preserved (≥50%) ejection fraction (HFpEF) incidence.

Women experienced greater heart failure declines than men (-43% versus -29%; P=0.06).

"Our findings document a major change in the epidemiology of heart failure, which is consistent with the recent changes in the epidemiology of acute coronary syndrome," the researchers wrote.

'Heart Failure Treatment Not Just About the Heart'

The findings also have major implications for the treatment of heart failure, Roger told 麻豆传媒.

Among patients who did develop heart failure during the 10-year observation period, hospitalization rates and prognosis did not decline significantly, she said.

Hospitalizations were common (mean 1.34 per person-year, 95% CI 1.25-1.44), and patients with HFpEF and HFrEF had similar rates of hospitalization. Well over half (63%) of hospitalizations were due to noncardiovascular causes.

"We saw a shift toward more noncardiovascular hospitalizations and deaths," Roger said. "This makes it clear that to improve outcomes we need to look beyond the heart. We need to manage these patients in a holistic, and not a disease-centric, way."

From Jan. 1 of 2000 to Dec. 31 of 2010, 2,762 incident cases of heart failure (mean age 76.4 years, 57% female) were identified in Olmsted County, which has a mostly Caucasian population of approximately 144,000 people. Subsequent hospitalizations among these patients through 2012 and deaths through 2014 were included in the analysis.

Five-year follow-up mortality was high (20.2% at 1-year post diagnosis and 52.6% at 5 years) and mortality rates did not decline over time. More than half of deaths (54.3%), however, were ascribed to noncardiovascular causes.

"Among 1,700 patients with cause of death available, the top three categories of noncardiovascular causes of death were respiratory (n=241, 14.2%), neoplasm (n=215, 12.6%), and mental or behavioral health (n=121, 7.1%)," the researchers wrote.

In addition to age, characteristics associated with higher mortality included diabetes mellitus, smoking, and increasing number of comorbidities.

'HFpEF Treatments Urgently Needed'

Hospitalization rates were similar among patients with HFpEF and HFrEF, with a suggestion of a higher rate of cardiovascular hospitalization among HFrEF patients and higher noncardiovascular hospitalization rates among HFpEF patients.

"Heart failure with preserved ejection fraction has been a very elusive target for drug development. We don't have efficacious treatments," Roger said. "There is an urgent need from a research standpoint to better understand this form of heart failure and identify drugs to treat it."

HFpEF is more commonly seen in women than men, and more than half of the study population (57%) was female. This may explain why 53% of the heart failure cases in the study involved preserved ejection fraction, cardiologist Mary Norine Walsh, MD, of St. Vincent Heart Center, Indianapolis, Indiana, wrote in an editorial published with the study.

"For most randomized trials and registries examining therapies for HFrEF, the enrollment of women has been roughly 25%," she wrote.

Walsh also noted that the homogeneous nature of the Olmsted County population, which is overwhelmingly white, middle class, and insured, makes it difficult to extrapolate the findings to dissimilar populations.

"Minnesota residents are of 86% white race/ethnicity, 94% of the population older than 25 years have a high school diploma, and the percentage living below the poverty level is in single digits," she wrote. "In addition, 95% of the population has health insurance. Although this population has been a great source of information on the classification, incidence, and prognosis of heart failure, generalization to other more diverse and underserved populations must be done with care."

From the American Heart Association:

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