Epidemiology and causes of heart failure
- Ramachandran S Vasan, MD, DM, FACC
Ramachandran S Vasan, MD, DM, FACC
- Professor of Medicine
- Boston University School of Medicine
- Peter WF Wilson, MD
Peter WF Wilson, MD
- Professor of Medicine
- Emory University School of Medicine
Aging of the population and prolongation of the lives of cardiac patients by modern therapeutic innovations has led to an increasing prevalence of heart failure (HF). Despite improvements in therapy, the mortality rate in patients with HF has remained unacceptably high , making early detection of susceptible persons who would benefit from preventive measures imperative.
The epidemiology and causes of HF will be reviewed here. Diastolic dysfunction, asymptomatic left ventricular dysfunction, and causes of HF decompensation are discussed separately. (See "Clinical manifestations and diagnosis of heart failure with preserved ejection fraction" and "Evaluation and management of asymptomatic left ventricular systolic dysfunction" and "Evaluation of acute decompensated heart failure".)
MAGNITUDE OF THE PROBLEM
The magnitude of the problem of heart failure (HF) cannot be assessed with precision since reliable, population-based estimates of its prevalence, incidence, and prognosis are lacking [2,3]. Part of the problem is that large differences exist among studies in their definition of the condition and the methods used to establish its presence. In addition, presymptomatic left ventricular (LV) dysfunction is now used increasingly as an indicator of impending, if not existing, HF .
Prevalence — At least six HF scoring methodologies based upon symptoms and signs have been developed to assess the presence of HF. Clinical diagnostic criteria for HF have generally included history, physical examination, and chest radiographs [5,6]. A 2013 update from the American Heart Association (AHA) estimated that there were 5.1 million people with HF in the United States in 2006 . There are an estimated 23 million people with HF worldwide .
Regardless of the definition used, the prevalence of HF and LV dysfunction increases steeply with age [1,9-14]. As an example, the Framingham Heart Study found a prevalence of HF in men of 8 per 1000 at age 50 to 59 years, increasing to 66 per 1000 at ages 80 to 89 years; similar values (8 and 79 per 1000) were noted in women . The prevalence in African-Americans is reported to be 25 percent higher than in whites.
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- MAGNITUDE OF THE PROBLEM
- - Preserved systolic function
- - Relative incidence of HFrEF and HFpEF
- - Older adults
- - Younger adults
- Lifetime risk
- PREDISPOSING CONDITIONS FOR HF
- Frequency of various causes
- - In developing countries
- Ischemic cardiomyopathy
- - Post-MI
- Left ventricular hypertrophy
- Comparing predisposing conditions for HFpEF and HFrEF
- PREVENTION OF HEART FAILURE
- Risk factor reduction
- Asymptomatic left ventricular dysfunction
- INFORMATION FOR PATIENTS