ECHO 2013 / Heart Failure The Growing Epidemic
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Heart Failure: The Growing
Epidemic
Donna Mancini, MD
Choudhrie Profssor of Cardiology
Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
Affiliation/Financial Relationship |
Company |
• Consulting Fees/Honoraria |
• Transmedics, Novartis |
“Epidemic” of Heart Failure in
the US
•5.8 million cases
•600,000 incidence cases/yr
•1 million hospital admissions annually
•300,000 deaths/yr
•Cost >$35 billion/yr
Iceberg Phenomena
Symptomatic HF
Stage C & D
Asymptomatic HF
Stage B
At Risk for HF
Stage A
6 million patients
Stage |
Description |
Treatment |
|
|
|
|
|
A |
HT,diabetes,CAD, |
Rx HT, lipid disorders |
|
At risk for HF |
cardiotoxins, |
Smoking cessation, exercise |
|
Limit ETOH |
|||
|
Family hx |
||
|
|
ACE in appropriate pts |
|
B |
Prior MI, LVSD, |
All measures in stage A |
|
Structural |
valvular disease |
ACE and β blockers in |
|
|
|
||
Heart Disease; |
|
Appropriate pts |
|
|
|
||
no symptoms |
|
|
|
C |
Structural disease |
Restrict Na |
|
|
|
||
Symptoms |
with SOB, fatigue, |
Diuretics,digoxin, |
|
|
ACE and β blockers |
||
|
decreased exercise |
||
|
capacity |
|
|
D |
Symptoms at rest |
All measures in stages A,B,C |
|
|
Mechanical devices, |
||
Refractory |
despite maxium |
||
|
|
||
|
medical therapy |
|
Population Estimate of Stage D Patients
Miller JACC 2013
Characteristics of HF
Preserved vs Reduced EF
Characteristics |
Reduced |
Preserved |
P Value |
Adjusted P |
|
EF(N=2429) |
EF(N=2167) |
|
Value |
|
|
|
|
|
Age (yr) |
71.7±12.1 |
74.4±14.4 |
<0.001 |
<0.001 |
|
|
|
|
|
Male sex (% ) |
35.4 |
44.3 |
<0.001 |
0.17 |
|
|
|
|
|
BMI |
28.6±7.0 |
29.7±7.8 |
0.002 |
0.002 |
|
|
|
|
|
Obesity (%) |
35.5 |
41.4 |
0.007 |
0.30 |
|
|
|
|
|
Serum Cr |
1.6±1.0 |
1.6±1.1 |
0.31 |
<0.001 |
(mg/dl) |
|
|
|
|
|
|
|
|
|
(** dbl check ref) N Engl J Med 355:3
Characteristics |
Reduced |
Preserved |
P Value |
Adjusted P |
|
EF(N=2429) |
EF(N=2167) |
|
Value |
Hgb (g/dl) |
12.5±2.0 |
11.8±2.1 |
<0.001 |
<0.001 |
HT (%) |
48.0 |
62.7 |
<0.001 |
<0.001 |
CADe (%) |
63.7 |
52.9 |
<0.001 |
<0.001 |
A fib (%) |
28.5 |
41.3 |
<0.001 |
<0.001 |
Diabetes |
34.3 |
33.1 |
0.42 |
0.61 |
valve disease |
6.5 |
2.6 |
<0.001 |
0.05 |
(% ) |
|
|
|
|
EF (%) |
29±10 |
61±7 |
<0.001 |
NA |
***N Engl J Med 355:3
Economic Impact
•5.8 million Americans w HF
•>600,000 patients diagnosed each year
•15 million office visits
•6.5 million hospital days each year
•Annual hospitalizations: >1 million as primary diagnosis; >3 million as primary or secondary diagnosis
•Rehospitalization rate of 25% within 1 month; 50% within 6 months
•Estimated direct and indirect cost of HF in 2010 is $39.2 billion
Hospital Discharges/Ambulatory
care Visits
•Hospital discharges for HF increased from 877,000 in 1996 to 1,106 000 in 2006
•Data from Ambulatory Medical Care Utilization Estimates for 2007 showed the number of visits for HF was 3,434 000.
Graves EJ, Kozak LJ. Detailed diagnoses and procedures: National Hospital Discharge Survey, 1996. Vital Health Stat 13. 1998;i–iii:1–151.
27Schappert SM, Rechtsteiner EA. Ambulatory Medical Care Utilization Estimates for 2007. Hyattsville, Md: National Center for Health Statistics.
Natl Health Stat Rep. In press.