ECHO 2013 / Heart Failure The Growing Epidemic
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Hospital Discharges for HF by Gender from 1979-2006
WRITING GROUP MEMBERS et al. Circulation 2010;121:e46-e215
Copyright © American Heart Association
Sources of HF Epidemiology Data
•Cohort Studies
Framingham
Rochester-Mayo Olmstead County
Pro: in and out patient data w consistent definition of HF
Con: small local homogeneous population
Sources HF Epidemiology Data
•Administrative Databases
Medicare
Health care networks
•Generally only hospitalized patients
•Derived from administrative billing Codes
•Lack of clinical information
•Variable definitions of HF
HF Incidence by age and sex (FHS 1980–2003). Source: NHLBI
WRITING GROUP MEMBERS, et al. Circulation 2010;121:e46-e215
Incidence: Time Trends and Gender
|
Men |
|
Women |
|
Period |
Incidence |
Rate ratio |
Incidence |
|
|
(rate/100,000 |
|
(rate/100,000 |
|
|
person yrs) |
|
person yrs |
|
1950-1969 |
627 |
1.00 |
420 |
1 |
1970-1979 |
563 |
0.87 |
311 |
0.63 |
1980-1989 |
536 |
0.87 |
298 |
0.6 |
1990-1999 |
564 |
0.93 |
327 |
0.69 |
Levy, NEJM 2002;347:1397
Incidence: Time Trends and Gender
Olmstead County, Minnesota (JAMA 2004;292:344-350) Rate /100,000 person yr. Age adjusted rate ratios
Men |
360 |
390 |
375 |
383 |
Rate Ratio |
1.00 |
1.07 |
1.01 |
1.04 |
Women |
284 |
292 |
260 |
315 |
Rate Ratio |
1.00 |
1.04 |
0.93 |
1.11 |
Olmstead County: 1979-1984 vs 1996-2000
4% increase in men
11% increase in women
Age Adjusted Incidence of HF
•Resource Utilization Among CHF Study-Henry Ford Health System
From 1989-1999: age adjusted incidence increased in women 3.7-4.2 cases/1000 pts; no change in men 4.0-3.7 cases/1000pts
Incident HF by sex and race In the Health, Aging, and
Body Composition Study cohort
Kalogeropoulos, A. et al. Arch Intern Med 2009;169:708-715.
Age-specific incidence of HF among Medicare beneficiaries from 1/94-12/03.
HF increased slightly among the youngest and declined among older beneficiaries.
From: Incidence and Prevalence of Heart Failure in Elderly Persons, 1994-2003
Arch Intern Med. 2008;168(4):418-424. doi:10.1001/archinternmed.2007.80
Incidence
•Trends similar or higher over time
•Higher in Men
•Higher in blacks
•Increase with age
•Higher in individuals with Coronary Artery Disease
•Highest in Black Males and lowest in white females