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Heart Failure Incidence Falls in U.K., but Absolute Number Rises

Heart Failure Incidence Falls in U.K., but Absolute Number Rises

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Action Points

  • Note that this observational study using U.K. data found that the incidence of heart failure, as expressed in terms of person-years, has declined modestly over time.
  • Paradoxically, the absolute number of new heart failure cases has risen, due primarily to aging and expansion of the population.

The number of heart failure patients in the U.K. now rivals the total number of patients with the four most common causes of cancer, a new study finds.

More than 920,000 people were living with heart failure in the U.K. in 2014. While overall decreases in heart failure incidence were documented, heart failure cases increased between 2002 and 2014 due to several factors including the aging of the population, population growth, and increased longevity, researchers found.

They speculated that this increase may be partly due to better survival following myocardial infarction.

The study was published online Nov. 21 in The Lancet.

“Despite a modest decline in standardized incidence, there has been a 12% increase in the total number of new cases of heart failure,” wrote researcher Kazem Rahimi, DM, MSc, of the George Institute for Global Health UK and the University of Oxford, and colleagues. “This is substantial, and by comparison is now similar to the total number of new cases of breast, prostate, lung, and bowel cancer combined.”

The population-based study represents the largest investigation of heart failure incidence linking primary and secondary health records to capture the full burden of heart disease and distinguish between new and existing cases of heart failure, the researchers wrote.

The study, which included data on 4 million adults in the U.K., documented a 7% overall reduction in heart failure incidence between 2002 through the end of 2014: from 358 cases to 332 cases per 100,000 person years, with an adjusted incidence rate ratio of 0.93 (95% CI, 0.91-0.94).

Notable heart failure increases were seen in the very elderly — people older than 85 years old — who have traditionally been excluded from randomized trials examining treatments for heart failure.

The reported 12% increase in the estimated absolute number of newly diagnosed heart failure cases and the 23% increase in the number of prevalent heart failure cases during the 12-year period were called “concerning” in an editorial published with the study.

“Although new heart failure cases can be viewed as an ironic success if they arise from more patients surviving myocardial infarction because of advances in acute coronary syndrome management, these cases should be viewed as failures when they originate from poor adherence to heart failure prevention strategies — for example, inadequate hypertension control,” wrote Faiez Zannad, MD, PhD, of the French National Institute of Health and Medical Research.

Zannad noted that the modest downward trend in heart failure incidence has been accompanied by a much more robust decline in myocardial infarction incidence, “suggesting that heart failure prevention strategies have been less successful than have strategies to prevent coronary artery disease.”

The data used in the study came from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the population of the U.K. in terms of age and sex. Eligible patients included people age 16 years and older for whom data were collected between Jan. 1, 2002 and Dec. 31, 2014.

Among the secondary findings from the study:

  • Patient age and multi-morbidity at first presentation of heart failure increased during the study period (mean age 76·5 years [SD 12·0] to 77·0 years [12·9], adjusted difference, 0·79 years, 95% CI, 0·37–1·20;
  • The mean number of comorbidities also increased from 3·4 [SD 1·9] to 5·4 [2·5]; adjusted difference 2·0, 95% CI, 1·9–2·1).
  • Socioeconomically deprived people had a higher rate of heart failure than affluent people (incidence rate ratio 1·61, 95% CI, 1·58–1·64), and they tended to be diagnosed earlier (adjusted difference –3·51 years, 95% CI, –3·77 to –3·25).
  • Socioeconomically deprived individuals also had more comorbidities, despite their younger age.

“The disparities we have identified in the U.K. point to a potentially preventable nature of heart failure that still needs to be tackled, and to potential opportunities for more targeted and equitable prevention strategies,” Rahimi noted in a written press release. “Achieving equal access and use of healthcare is an important goal, and in this instance could help tackle the biological, environmental and behavioral risk factors that put people from more deprived backgrounds at greater risk of heart failure.”

Study limitations cited by the researchers included the introduction of a national care monitoring program during the study period, which may be responsible for some of the variation seen in specific years, and the lack of data on specific heart failure type.

The large, representative, heterogeneous cohort was cited as a major study strength.

“This population-based approach increases the generalizability of the findings compared with surveys that select participants,” the researcher wrote. “Moreover, in view of the similarity of trends in cardiovascular disease and population aging from the U.K. with other European countries, North America and Australia, our findings are likely to be broadly applicable to much of the rest of the developed world.”

Funding for the study was provided by the British Heart Foundation and the National Institute for Health Research.

The researchers declared no relevant relationships with industry related to this study.

  • Reviewed by
    F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2017-11-22T13:00:00-0500

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