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No Drop in Incidence of Heart Failure

But survival has inched up over 20 years, study finds

TUESDAY, July 20, 2004 (HealthDayNews) -- A Midwestern study finds little improvement over the last 20 years in the incidence of heart failure, a major cause of debility and death in older Americans.

Perhaps 5 million Americans have heart failure, a condition in which the vital organ progressively loses its ability to pump blood. The new study, using data on more than 5,500 residents of a Minnesota county, found no decrease in the incidence of heart failure over the past two decades.

There is some good news, said Dr. Veronique L. Roger, lead author of the report in the July 21 issue of the Journal of the American Medical Association, but not nearly as much as hoped.

While the overall incidence of heart failure did not go down over the past two decades, "survival after onset of heart failure has increased, with less improvement among women and elderly persons," the researchers said.

"It's better news than if it were increasing, but we'd like to see it go down further," said Rogers, a professor of medicine at the Mayo Clinic.

There are economic as well as medical reasons to understand why the heart failure picture remains static and to hope for improvement, Roger said. Heart failure is the leading cause of hospitalization in 65-and-older Americans, costing the nation billions of dollars, yet there have been surprisingly few studies of the condition, she said.

The Mayo results are in general agreement with those of the Framingham Heart Study, which has followed residents of a Massachusetts community for decades. But there are some signs of improvement in both studies, said Dr. Ramachandran S. Vasan, an associate professor of medicine at Boston University School of Medicine and a leader of the Framingham study.

"The incidence rate has come down in men, and there are improvements in survival," Vasan said. "Maybe there are some measures in place that have yet to take effect and will lead to improvements over a period of decades rather than a few years."

In the Mayo study, the incidence of heart failure in men was 378 per 100,000; in women, it was 289 per 100,000. Those numbers did not change significantly over the course of the study.

But there was an improvement in survival, with a the five-year age-adjusted survival rate at 52 percent in 1996-2000, compared to 43 percent in 1979-1984.

"Men and younger persons experienced larger survival gains, contrasting with less or no improvement for women and elderly persons," the researchers reported.

There is a gaping hole in both the Mayo and Framingham studies. The overwhelming number of participants in both studies happen to be white. There are no comparable studies in minority populations, in whom the incidence of heart failure is believed to be high, Vasan and Roger said.

Nevertheless, the new study does add valuable information, both said.

"Any time we gain an understanding in what may be happening, it is good news because it helps focus the efforts of health providers," Roger said.

And Vasan sees reason for hope. "There may be some measures in place that still have to take effect," he said. "Improvement may occur over a period of decades rather than a few years. I am optimistic that the rate will come down."

More information

Learn about heart failure, its symptoms and its treatment from the American Heart Association.

SOURCES: Veronique L. Roger, M.D., M.P.H., professor, medicine, Mayo Clinic, Rochester, Minn.; Ramachandran S. Vasan, M.D., associate professor, medicine, Boston University School of Medicine; July 21, 2004, Journal of the American medical Association
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