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 Researchers examined data from the U.S. Centers for Disease Control
and Prevention (CDC) on deaths from heart failure between 1999 and
2017 among adults 35 to 84 years old.
Between 1999 and 2012, annual heart failure death rates dropped from
78.7 per 100,000 people to 53.7 per 100,000, the researchers found.
But then mortality rates started to climb, reaching 59.3 fatalities
for every 100,000 people by the end of the study period.
"Up until 2012, we saw decline in cardiovascular deaths in patients
with heart failure and this was likely due to advances in medical
and surgical treatments for heart failure," said senior study author
Dr. Sadiya Khan of Northwestern University Feinberg School of
Medicine in Chicago.
"However, this study demonstrates for the first time that the
cardiovascular death rate is now increasing in patients with heart
failure and this increase is especially concerning for premature
death in people under 65," Khan said by email.
About 5.7 million American adults have heart failure, according to
the CDC, and about half of the people who develop this condition die
within five years of diagnosis. Heart failure happens when the heart
can't pump enough blood and oxygen to supply vital organs.
In the study, African Americans were more likely to die of heart
failure than whites, and this disparity was especially pronounced
among younger adults, researchers report in the Journal of the
American College of Cardiology.
Compared to white men, black men had a 1.16-fold higher risk of
death from heart failure in 1999 but a 1.43-fold higher mortality
risk by 2017, the study found.
And, compared to white women, black women started out with a
1.35-fold higher risk of death from heart failure and had a
1.54-fold greater risk by the end of the study period.
When researchers looked just at adults 35 to 64 years old, the
racial disparity was even starker: by 2017 black men had a 2.60-fold
higher risk of death from heart failure and black women had a 2.97
fold higher risk of death.
"More than 50 percent of black adults have hypertension and have
high rates of obesity and diabetes, and this may explain a portion
of the disparities in heart failure mortality," Khan said.
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"Beyond differences in risk factor prevalence, disparities in access
to care unfortunately contribute to both inadequate prevention and
diagnosis," Khan added. "We need to do better in terms of access to
care for all Americans."
The study used data from the CDC that includes the underlying and
contributing cause of death from all death certificates in the U.S.
between 1999 to 2017 - for a total of more than 47.7 million people.
The study wasn't designed to determine what might be causing the
rise in heart failure deaths.
"Some have speculated this mortality increase has to do with
increased prevalence of heart failure risk factors of diabetes and
obesity," said Dr. Gregg Fonarow, a cardiologist and researcher at
the University of California, Los Angeles, who wasn't involved in
the study.
However, it's also possible that a recent shift in Medicare payment
rules designed to curb repeat hospitalizations may have "also
contributed to the increases in mortality by restricting necessary
care, particularly in the most vulnerable heart failure patients,"
Fonarow said by email.
While black men are more likely to develop heart failure at younger
ages, and less likely to receive recommended treatments, they're
also more likely to be treated at hospitals that are
disproportionately impacted by Medicare efforts to curb repeat
hospitalizations, or readmissions, Fonarow said.
"Heart failure is preventable and treatable," Fonarow said. "There
is an urgent need . . . to eliminate the healthcare policy that has
been associated with the increase in heart failure deaths."
SOURCE: https://bit.ly/2PPYf88 JACC, online May 6, 2019.
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