Assessing the Population Burden From Heart Failure

Abstract

IN PART because of the aging of the American population and improved survival following coronary heart disease, heart failure (HF) is assuming increasing public health and clinical importance. While few recent or population-based data are available to systematically characterize the present population burden from HF, estimates are that approximately 4.9 million Americans have a diagnosis of HF, about 400,000 new cases occur annually, and more than 43,000 individuals died of HF in the United States as recently as 1995,^1,2 although death certificate data likely underestimate the contribution of this disease to overall and cause-specific mortality. Reflecting the ever-increasing magnitude of this condition and associated costs, the number of hospitalizations for HF rose from 377,000 in 1979 to 872,000 in 1995.¹ Deaths attributed to HF increased by more than 100% between 1979 and 1995, and death rates in 1995 were highest for black men (8.8 per 100,000) followed by black women (7.1 per 100,000), white men (6.7 per 100,000), and white women (5.4 per 100,000). Based on data from the nationally representative National Health and Nutrition Examination Survey III carried out from 1988-1991, approximately 2.8% of non–Hispanic adult white men and 2.2% of women have HF. In contrast, approximately 3.2% of non–Hispanic black men and 2.8% of women have a diagnosis of HF.³ Heart failure is the single most frequent cause for hospitalization in individuals aged 65 years or older and the incidence of HF approaches 10 per 1000 population in elderly individuals. The prognosis associated with HF is grim, based on data from the population-based Rochester, Minn, and Framingham, Mass, studies, with 1-year mortality rates averaging between 35% and 45% in newly diagnosed cases.^4,5