The Alarming Rise in Heart Failure Mortality Rates
Heart failure has long been a significant health concern in America, but recent data suggests a troubling trend of increasing mortality rates related to this condition. A study published in JAMA Cardiology reveals that the death rate from heart failure is now 3% higher than it was 25 years ago, reversing years of progress in reducing fatalities.
The Grim Statistics
The study, based on death certificate data, highlights a concerning pattern in heart failure mortality rates over the past two decades. While the death rate declined significantly from 1999 to 2009, it plateaued for a few years before sharply rising from 2012 to 2019. The pandemic years of 2020 and 2021 saw a further acceleration in deaths from heart failure.
A Call to Action
Veronique Roger, MD, MPH, from the National Heart, Lung, and Blood Institute, emphasizes the urgent need for action to combat this concerning trend. She notes that while progress was made in reducing overall cardiovascular disease mortality during the 2000s, the increase in deaths attributed to heart failure is eroding those achievements.
The Impact on Different Age Groups
While people aged 65 and older are traditionally more at risk for heart failure-related mortality, the study reveals a notable increase in death rates among younger Americans. From 2012 to 2021, there was a nine-fold increase in heart failure deaths among people under 45 and a four-fold increase among those aged 45 to 64.
The Role of Comorbidities
Marat Fudim, MD, from Duke University, attributes the rise in heart failure deaths among younger individuals to the increasing prevalence of comorbidities like obesity and diabetes. These conditions, often developed in early adulthood, can lead to heart failure in middle age, underscoring the importance of preventive measures.
Factors Contributing to the Rise in Mortality Rates
The study highlights several factors influencing the surge in heart failure mortality rates, including the impact of the COVID-19 pandemic. Patients hospitalized for COVID-related pneumonia were found to have a higher risk of developing heart failure, exacerbating the existing upward trend in fatalities.
Challenges in Healthcare Systems
Sadiya S. Khan, MD, from Northwestern University, points to deficiencies in healthcare systems as a contributing factor to the reversal of heart failure mortality trends. Limited access to care, especially in underserved areas, and a lack of emphasis on prevention and chronic care may be hindering effective management of heart failure patients.
Looking Towards Solutions
As the mortality rates from heart failure continue to climb, healthcare professionals stress the importance of implementing new strategies to combat this trend. Roger and Fudim highlight the need for innovative research, preventive measures, and improved clinical practices to address the rising challenges posed by heart failure mortality.
Urgency for Change
Despite efforts to improve care for heart failure patients, the persistently high mortality rates underscore the pressing need for a comprehensive approach to combating this condition. The increasing prevalence of heart failure highlights the critical importance of addressing underlying comorbidities and enhancing access to quality healthcare for all individuals.
Additional Insights
While advancements in treating ischemic heart disease have seen success in reducing mortality rates, the lack of comparable progress in managing heart failure is concerning. Addressing the root causes of heart failure, such as obesity and diabetes, is crucial in reversing the current trend of escalating fatalities associated with this condition.
Challenges Ahead
The prevalence of obesity and diabetes poses significant challenges to efforts in reducing heart failure mortality rates. Healthcare systems must prioritize preventive measures, enhance access to care, and focus on addressing the underlying factors contributing to the rise in fatalities. Collaborative efforts across medical disciplines and public health initiatives are essential in turning the tide on heart failure mortality.
Summary
The increase in heart failure mortality rates in America poses a significant public health challenge, with younger individuals increasingly impacted by this condition. While efforts have been made to improve care and reduce cardiovascular disease mortality, the rise in heart failure deaths underscores the need for a comprehensive and proactive approach to address the root causes of this issue. By prioritizing prevention, enhancing access to care, and advancing research in heart failure management, healthcare systems can strive towards reversing the current trend and improving outcomes for individuals affected by this condition.
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May 3, 2024: Today, Americans are dying from heart failure at a higher rate than in 1999, reversing years of progress in reducing the death rate.
That is the clear message of a new JAMA Cardiology study, which finds that the current death rate from heart failure is 3% higher than 25 years ago. According to the study, based on death certificate data, the death rate fell significantly from 1999 to 2009, then plateaued for a few years before rising sharply from 2012 to 2019. During the pandemic years of 2020 and 2021, In the last year for which data is available, deaths from heart failure accelerated.
“These data are surprising,” said Veronique Roger, MD, MPH, chief of the epidemiology and community health branch at the National Heart, Lung, and Blood Institute. “They really constitute an urgent call to action to reverse this trend.”
Roger, who was not involved in the study, noted that during the 2000s, the death rate from cardiovascular disease decreased and has now stabilized, largely due to the increase in deaths attributed to heart failure. “This document shows that not only are we not making progress, but our achievements are being eroded. So it is an important agreement.”
According to the National Institutes of Health, about 6.7 million Americans today suffer from heart failure. This is just a snapshot in time, of course: About 1 in 4 Americans will develop heart failure during their lifetime, the NIH said. Approximately half of those with the condition dies within 5 years of diagnosis.
People aged 65 and older are much more likely to die from heart failure than younger people. However, the relative increase in the death rate was most marked among younger Americans, according to the study. Among people under 45, there was a nine-fold increase in heart failure deaths from 2012 to 2021, and there was a nearly four-fold increase among people ages 45 to 64.
Comorbidities cause heart failure
According to study co-author Marat Fudim, MD, associate professor of cardiology at Duke University in Durham, North Carolina, the increase in heart failure deaths among younger people is likely related to the fact that obesity and diabetes have become more prevalent among younger people. young adults. It is not surprising, she said, that an increasing number of people with these disorders develop heart failure in middle age.
Otherwise, he said, “the reversal of [heart failure mortality] The trends appear to have affected men and women and different races in very similar ways. He did not discriminate in that or between rural versus urban residents. “While there were marked differences between racial groups and between rural and urban areas in heart failure mortality rates, the reverse trend is very similar among all of these groups.”
“What we see in clinics is that comorbidities lead to heart failure,” said Fudim, whose own cardiology practice specializes in this condition. “Heart failure is rarely a single disease problem. Typically, patients with heart failure have obesity, diabetes, heart artery disease, hyperlipidemia; “All of these diseases cause heart failure, which leads to mortality.”
The increase in mortality from heart failure predates the COVID-19 pandemic, but COVID accelerated the increase in deaths from this condition. From 2012 to 2019, the average annual percentage change in mortality was 1.82%; during 2020 and 2021 it was 7.06%.
Fudim said there were two reasons for this. First, patients who were hospitalized for COVID-related pneumonia were about 20% more likely to develop heart failure than other people, after adjusting for their health status. Additionally, COVID worsened health disparities related to race and income, and caused the health system to focus on COVID-related care rather than heart failure prevention or treatment.
Factors influencing the increase in mortality rate
A co-author of a previous paper showing an increase in the rate of heart failure deaths agreed that COVID was “like adding fuel to the fire” of heart failure mortality.
Sadiya S. Khan, MD, the Magerstadt P.The professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine in Chicago also agreed that the increase in the number of middle-aged people dying from this condition is likely related to comorbidities that they developed earlier in life. Khan added kidney disease to the list of possible disorders linked to death from heart failure. And he said he’s also seeing an earlier onset of heart failure.
Khan’s research group published a paper showing that the death rate from heart disease due to hardening of the arteries (known as ischemic heart disease, which often leads to heart attacks) decreased even as the death rate from heart failure increase. She attributes this primarily to there being better treatments for the underlying heart disease.
“For ischemic heart disease, there have been many advances in effective therapies, particularly related to stenting and effective lipid-lowering therapies with statins and some new therapies. “We haven’t seen the same progress in heart failure.”
Another factor that could have contributed to the increased mortality rate is the prevalence of heart failure. If more people develop heart failure, more will die from it. On the other hand, Roger and Fudim said, a higher mortality rate could result from heart failure patients being sicker than before, even without higher prevalence. Fudim said the data shows that the rate of heart failure is quite stable but gradually increasing.
Where did we go wrong?
Khan study from 2019 suggested that the previous decline in deaths from cardiovascular disease reflected the success of policies aimed at increasing blood pressure and cholesterol control, along with higher 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 rates has plateaued, and heart failure-related cardiovascular disease mortality rates are increasing,” the document states. .
If so many things were being done right, why did the heart failure mortality trend reverse?
Roger does not blame the doctors, who, in his opinion, are still doing the right thing.
“What we have not done well is not having managed to control obesity and diabetes. Diabetes travels with obesity, so if we focus solely on obesity, the decisions that you, I and everyone make when we eat are not in the doctor’s office,” Roger said.
“I think we’ve done the best we could with the things that are within our control,” he said. “But that is offset by trends in obesity, which are related to the consumption of ultra-processed foods, sugary drinks, etc.”
Fudim, on the other hand, believes that the health system is at least partly to blame for the reversal of the heart failure mortality trend. In part because of the shortage of primary care, he said, access to care is limited in many areas, prevention and chronic care are being undervalued, and some heart failure patients are not getting the care they need.
Roger agreed. He cited the substantially higher heart failure death rate among blacks as evidence that “both difficulties accessing the health care system and the quality of health care play a role.”
On the other hand, he said, health systems have prioritized improving care for heart failure patients, in part because of Medicare incentives. The increase in the rate of deaths from heart failure, despite all these efforts, she said, should be “an urgent wake-up call.” There are new avenues of research, prevention and clinical practice that must be combined to address or mitigate this trend because we cannot allow it to continue like this.”
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