May 3, 2024 — Americans are now dying from heart failure at a higher rate than in 1999, reversing years of progress in reducing mortality rates.
That is someone's solemn message. new JAMA Cardiology study, the current heart failure mortality rate is 3% higher than it was 25 years ago. Based on death certificate data, the study says mortality rates dropped significantly from 1999 to 2009, then leveled off for several years, and then increased sharply from 2012 to 2019. The data was the most recent in 2020 and 2021, the pandemic years. availability accelerates deaths from heart failure.
„These data are surprising,“ said Veronique Roger, MD, MPH, director of the Division of Epidemiology and Community Health at the National Heart, Lung, and Blood Institute. “These really serve as an urgent call to action to reverse this trend.”
Roger, who was not involved in the study, noted that cardiovascular disease mortality rates declined in the 2000s and have now leveled off, but this is largely due to a sharp increase in deaths from heart failure. „This paper shows that not only are we not making progress, but our interests are being eroded. So this is a big deal.“
by National Institutes of Health, approximately 6.7 million Americans currently have heart failure. Of course, this is just a fleeting moment, and the NIH says that about one in four Americans will develop heart failure in their lifetime. Approximately half of people with symptoms Death occurs within 5 years after diagnosis.
People over 65 are much more likely to die from heart failure than younger people. However, the relative increase in mortality was most pronounced among younger Americans, according to the study. From 2012 to 2021, deaths from heart failure in people under the age of 45 increased ninefold, and almost fourfold in people aged 45 to 64.
Comorbidities lead to heart failure
Study co-author Marat Hudim, M.D., Ph.D., associate professor of cardiology at Duke University in Durham, North Carolina, believes that the increase in heart failure deaths among young people is likely due to obesity among young people. and the fact that diabetes is more prevalent. young adults. It's no surprise that an increasing number of people with these conditions are developing heart failure in middle age, he says.
Otherwise, „the reversal in trends[in heart failure mortality]appears to be affecting men and women and different races in very similar ways,“ he said. In this respect, there was no discrimination between rural and urban residents. Although there were clear differences in heart failure mortality rates between races and between rural and urban areas, reversal trends were very similar among all these groups. ”
„What we see in our practice is that comorbidities are causing heart failure,“ said Hudim, whose cardiology practice specializes in the disease. “Heart failure is rarely a problem with a single disease. Patients with heart failure usually have obesity, diabetes, cardiovascular disease, and hyperlipidemia. All of these diseases can cause heart failure and lead to death. Masu.“
Although increases in heart failure mortality predate the coronavirus disease (COVID-19) pandemic, COVID-19 has accelerated the increase in heart failure deaths. The average annual change in mortality rate from 2012 to 2019 was 1.82%. In 2020 and he was 7.06% in 2021.
Hudim said there are two reasons for this. First, after controlling for health status, patients hospitalized with coronavirus-related pneumonia were about 20% more likely to develop heart failure than other people. Additionally, COVID-19 has exacerbated health disparities related to race and income level, and the health care system has shifted its focus to COVID-19-related care rather than heart failure prevention and management.
Factors contributing to increased mortality rate
Co-authors of a previous paper showing an increase in heart failure mortality agreed that the coronavirus was „like adding fuel to the fire“ of heart failure mortality.
Sadiya S. Khan, MD Magelstadt PFeinberg, a professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine in Chicago, agreed that the increasing number of middle-aged people dying from the disease is probably related to comorbidities that developed earlier in life. . Khan added kidney disease to the list of potential conditions associated with death from heart failure. And early onset of heart failure is also seen, she said.
Kahn's research group published a paper showing that even though death rates from heart failure are rising, death rates from heart disease caused by arteriosclerosis, known as ischemic heart disease, are decreasing. She believes this is largely because there are better treatments for the underlying heart disease.
“For ischemic heart disease, there have been many advances in effective treatments, particularly related to stent implantation and effective lipid-lowering therapy with statins, as well as several new treatments.The same is true for heart failure. I see no progress.”
Another factor that may have contributed to increased mortality is the prevalence of heart failure. If more people develop heart failure, more people will die from heart failure. However, Rodger and Hudim said that even if prevalence is not increasing, death rates may be higher because heart failure patients are becoming more ill than before. Hudim said the data shows heart failure rates have remained fairly stable but are gradually rising.
Where did I go wrong?
Khan's 2019 study They suggested that the early decline in deaths from cardiovascular disease reflects the success of policies aimed at better control of blood pressure and cholesterol, along with increased rates of smoking cessation and effective drug use.
„However, the prevalence of obesity and diabetes has increased dramatically, overall CVD mortality declines have stalled, and heart failure-related CVD mortality is rising,“ the paper states. .
If so many things were being done right, why did heart failure mortality rates reverse?
In Roger's view, he doesn't blame doctors for continuing to do the right thing.
„What we didn't do right was fail to manage obesity and diabetes. Diabetes goes hand-in-hand with obesity, so if we focus only on obesity, we're not going to make you, me, and everyone better at eating.“ The choices you make are not something you make in a doctor's office,“ Roger said.
“I think we did the best we could within our control,” she said. „However, that is offset by obesity trends related to consumption of things like ultra-processed foods and sugar-sweetened beverages.“
In contrast, Hudim believes the health care system is at least partly responsible for the reversal in heart failure mortality. She said access to care is limited in many regions, in part due to a lack of primary care, with less emphasis on prevention and chronic care, and some heart failure patients are unable to receive the care they need. He said he could not.
Roger agreed. She cited the significantly higher heart failure death rate among Black people as evidence that „both the difficulty of accessing the health care system and the quality of care are at play.“
Meanwhile, the health system is prioritizing improving care for heart failure patients, in part because of Medicare incentives, she said. Despite all these efforts, the increase in mortality from heart failure „should be an urgent wake-up call,“ she said. This trend cannot continue unabated, and new avenues of research, prevention, and clinical practice should be leveraged synergistically to address or mitigate this trend. ”