HF mortality on the rise due to rapidly aging population

The 2010s saw a decrease in age-adjusted mortality associated with heart disease (HD), according to a JAMA Cardiology report published Oct. 30, but a concomitant rise in heart failure-related deaths and increase in the global population of adults over 65 actually resulted in an increase in the number of fatalities attributed to CVD.

Stephen Sidney, MD, MPH, of Kaiser Permanente Northern California, and co-authors leveraged data from the CDC’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) registry in an attempt to identify national changes in the incidence of deaths from HD, coronary HD (CHD), heart failure and other forms of CVD between 2011 and 2017. We know the number of older adults in the U.S. is increasing as medicine improves and more people live longer, but the authors said it’s unknown whether that population surge is associated with HD-related mortality.

Sidney et al. reported that, based on CDC WONDER data, the total population size of U.S. adults aged 65 and up increased by 22.9% over the six-year period, from 41.1 million in January of 2011 to 50.9 million in December of 2017. During the same time frame, the age-adjusted mortality rate decreased 5% for HD and 14.9% for CHD.

“The probable reasons for the deceleration in the decrease of the HD mortality rate were discussed in an earlier publication, with the most notable factors being the substantial increases in obesity and diabetes rates that began in the mid-1980s,” the authors wrote.

Despite that reduction in HD and CHD deaths, the team said age-adjusted mortality rates increased by 20.7% for heart failure and 8.4% for other HDs between 2011 and 2017. The number of deaths increased 8.5% for HD, 38% for heart failure and 23.4% for other heart diseases; 80% of HD deaths recorded were attributed to adults aged 65 and older.

Sidney and his colleagues wrote that the prevalence of HF in the U.S. is expected to increase by 37% between 2015 and 2030, with older adults experiencing an even steeper 57% increase. If it were separated from all other forms of CVD, the authors said, heart failure would be the eighth leading cause of death in the country.

Considering the fact that the number of adults aged 65 and up is estimated to grow by an additional 44% between 2017 and 2030, the authors said we need need novel approaches to address HD—and heart failure in particular—in the rapidly aging population.

“The projected..increase in the number of adults aged 65 years and older from 2017 to 2030 can be expected to create challenges for the capacity of public health and medical care efforts to prevent and manage HD,” they wrote. “Innovative and effective approaches for surveillance, prevention and treatment are needed to address the expanding burden of HD mortality.”