A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010

Abstract

Importance: Heart failure (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).

Design, setting, and participants: Incidence rates of HF in Olmsted County, Minnesota (population, approximately 144,248), between January 1, 2000, and December 31, 2010, were assessed.

Main outcomes and measures: Patients identified with incident HF (n = 2762) (mean age, 76.4 years; 43.1% male) were followed up for all-cause and cause-specific hospitalizations (through December 2012) and death (through March 2014).

Results: The age- and sex-adjusted incidence of HF declined substantially from 315.8 per 100,000 in 2000 to 219.3 per 100,000 in 2010 (annual percentage change, -4.6), equating to a rate reduction of 37.5% (95% CI, -29.6% to -44.4%) over the last decade. The incidence declined for both HF types but was greater (interaction P = .08) for HFrEF (-45.1%; 95% CI, -33.0% to -55.0%) than for HFpEF (-27.9%; 95% CI, -12.9% to -40.3%). Mortality was high (24.4% for age 60 years and 54.4% for age 80 years at 5 years of follow-up), frequently ascribed to noncardiovascular causes (54.3%), and did not decline over time. The risk of cardiovascular death was lower for HFpEF than for HFrEF (multivariable-adjusted hazard ratio, 0.79; 95% CI, 0.67-0.93), whereas the risk of noncardiovascular death was similar (1.07; 95% CI, 0.89-1.29). Hospitalizations were common (mean, 1.34; 95% CI, 1.25-1.44 per person-year), particularly among men, and did not differ between HFpEF and HFrEF. Most hospitalizations (63.0%) were due to noncardiovascular causes. Hospitalization rates for cardiovascular causes did not change over time, whereas those for noncardiovascular causes increased.

Conclusions and relevance: Over the last decade, the incidence of HF declined substantially, particularly for HFrEF, contrasting with no apparent change in mortality. Noncardiovascular conditions have an increasing role in hospitalizations and remain the most frequent cause of death. These results underscore the need to augment disease-centric management approaches with holistic strategies to reduce the population burden of HF.

Figure 1

Temporal trends in heart failure incidence rates, overall and by reduced/preserved ejection fraction among women (left panel) and men (right panel) in Olmsted County, Minnesota, 2000 to 2010. Yearly rates (smoothed using 3-year moving average) per 100,000 persons have been standardized by the direct method to the age distribution of the US population in 2010. HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction.

Figure 2

Estimated percent changes in heart failure incidence from 2000-2010 in Olmsted County, MN, overall and across specific demographic groups and heart failure types. The estimates are adjusted for age and sex (when applicable) and presented with 95% confidence intervals. HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; CI, confidence interval.