May 3, 2024—A higher percentage of Americans are dying from heart failure today than in 1999, reversing years of progress in reducing mortality.
This is a grim message new JAMA Cardiology study, the study found that the current mortality rate from heart failure is 3% higher than it was 25 years ago. The study said the mortality rate dropped sharply from 1999 to 2009, then stabilized for a few years before rising sharply from 2012 to 2019, based on death certificate data. The year shown.
“These data are shocking,” said Veronique Roger, MD, MPH, chief of the Division of Epidemiology and Community Health at the National Heart, Lung, and Blood Institute. “They do have an urgent call for action to reverse this trend.”
Roger, who was not involved in the study, noted that death rates from cardiovascular disease declined in the 2000s and have now leveled off, largely because of a surge in deaths from heart failure. “This paper shows that not only are we not making progress, but our gains are being eroded. So that’s a big deal.
according to National Institutes of Health, approximately 6.7 million Americans suffer from heart failure today. Of course, that’s just a snapshot: The National Institutes of Health says about one in four Americans will develop heart failure in their lifetime. About half of people with this disease Death within 5 years of diagnosis.
People 65 or older are much more likely to die from heart failure than younger people. However, research shows that the relative increase in mortality is most pronounced among young Americans. From 2012 to 2021, heart failure deaths increased nine-fold among people under 45 years old and almost quadrupled among those aged 45-64.
Comorbidities leading to heart failure
Study co-author Dr. Marat Fudim, associate professor of cardiology at Duke University in Durham, North Carolina, believes the increase in heart failure deaths among young people may be related to obesity and diabetes becoming more common in the population. It’s not surprising that more and more people with these conditions are developing heart failure in midlife, he said.
Otherwise, he said, ” [heart failure mortality] Fashion trends seem to hit men, women, and different races in very similar ways. It does not discriminate between rural residents and urban residents in this regard. Although there were clear differences in heart failure mortality between racial groups and between rural and urban areas, the reversal trends were very similar across all these groups.
“What we see in our practice is that comorbidities can lead to heart failure,” said Ferdim, whose own cardiology practice specializes in this condition. “Heart failure is rarely a single disease problem. Typically, people with heart failure have obesity, diabetes, heart disease, hyperlipidemia – all of these conditions can lead to heart failure and thus death.
The increase in heart failure mortality predates the COVID-19 pandemic, but COVID-19 has accelerated the increase in deaths from this disease. The average annual percentage change in mortality was 1.82% from 2012 to 2019; it was 7.06% between 2020 and 2021.
There are two reasons for this, Fodim said. First, after adjusting for health status, patients hospitalized with COVID-19 were about 20% more likely to develop heart failure than others. Additionally, the COVID-19 pandemic has exacerbated health disparities related to race and income levels, causing health systems to focus on COVID-19-related care rather than the prevention or management of heart failure.
factors that increase mortality
The co-author of an early paper showing an increase in heart failure mortality also believes that COVID-19 is “like adding fuel to the fire” on heart failure mortality.
Sadiya S. Khan, MD Magstadt PA professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine in Chicago also believes that the increase in deaths from the disease among middle-aged people may be related to comorbidities they suffered earlier in life. Khan added kidney disease to the list of potential conditions associated with death from heart failure. And, she says, she’s also seeing early onset of heart failure.
A paper published by Khan’s research group showed that even as death rates from heart failure increased, death rates from heart disease caused by hardening of the arteries (called ischemic heart disease, which often leads to heart attacks) fell. She believes this is largely because there are better treatments for underlying heart disease.
“For ischemic heart disease, there have been a lot of advances in effective treatments, particularly related to effective lipid-lowering therapy with stent placement and statins, as well as some new therapies. We haven’t seen the same progress in heart failure. Progress.
Another factor that may contribute to increased mortality is the prevalence of heart failure. If more people develop heart failure, more people will die from heart failure. On the other hand, even without an increase in prevalence, the fact that heart failure patients are sicker than before could lead to higher mortality rates, Roger and Ferdim said. Fordim said the data showed heart failure rates were fairly steady but gradually increasing.
Where did we go wrong?
Khan’s 2019 study The earlier decline in cardiovascular disease deaths reflects the success of policies aimed at tightening blood pressure and cholesterol control, as well as increased rates of people quitting smoking and using effective medications.
“However, the prevalence of obesity and diabetes has increased dramatically, the decline in overall cardiovascular disease mortality has stalled, and cardiovascular disease mortality related to heart failure is increasing,” the paper reads.
If so many things are done right, why is the trend in heart failure mortality reversed?
Roger didn’t blame the doctors; in her opinion, they continued to do the right thing.
“What we’re doing wrong is we’re failing to control obesity and diabetes. Diabetes goes with obesity, so if we only focus on obesity, then you and I and everyone make choices when they’re eating that’s not in the doctor’s office,” Roger said .
“I think we’ve done the best we can with the things within our control,” she said. “But this is offset by obesity trends, which are linked to consumption of ultra-processed foods, sugary drinks and more.”
In contrast, Ferdim believes the health system is at least partially responsible for the reversal in heart failure mortality trends. Part of the problem is a shortage of primary care, limited access to care in many areas, a lack of emphasis on preventive and long-term care, and some heart failure patients not getting the care they need, he said.
Roger agreed. She cited evidence of significant increases in heart failure mortality among black people as evidence that “both difficulty accessing the health care system and the quality of health care play a role.”
On the other hand, she said, health systems prioritize improving care for heart failure patients, in part because of Medicare incentives. Despite all these efforts, the rise in heart failure deaths should be “an urgent wake-up call,” she said. This trend should be addressed or mitigated with a combination of new research, prevention, and clinical practice avenues because we cannot let it continue this way.
