New Heart Failure Cases Rising Among Older Adults, MI Survivors

The UK study found that while total incidence has declined, new HF cases now rival annual rates of the four most common cancers combined.

New Heart Failure Cases Rising Among Older Adults, MI Survivors

Population grown and an aging population have led to an increase in the number of new cases of heart failure (HF) being diagnosed each year. A new study from the United Kingdom suggests that the number is now equal to the combined number of new cases of breast, prostate, lung and bowel cancer.

Although the total incidence of HF dropped by 7% in both men and women over the study period from 2002 to 2014, new HF cases were found to have increased by 12%.

In an email, senior author Kazem Rahimi, MD (University of Oxford, United Kingdom), said the modest declines in the incidence of HF have not kept pace with the much more rapid decline in the incidence of MI, which decreased by about one-third over the same period of time. Importantly, Rahimi and colleagues hypothesize that the rise in HF may be the result of more patients surviving MI due to improvements in care over the last decade.

“What we also found unexpected is that the number of comorbidities at the time of heart failure diagnosis continued to rise, and many of these were unrelated to cardiovascular conditions (eg, arthritis, chronic lung disease, or cancer),” Rahimi said. Average age at diagnosis of HF also was found to have risen.

 “The other unexpected finding was the known differences by socioeconomic status became more pronounced over time,” Rahimi added. “This is despite the fact that access to healthcare is free in the UK.”

Compared with more affluent individuals, those considered socioeconomically deprived were more likely to develop HF, and at a younger age.

An “Ironic Success?”

The study, published online November 21, 2017, ahead of print in the Lancet, and led by Rahimi’s colleague Nathalie Conrad, MSc, was based on health records from 4 million patients in the UK.

To TCTMD, Rahimi said the patterns observed in the UK-based population “are very likely to be similar to countries with aging populations, but this would require further research.”

In an editorial accompanying the study, Faiez Zannad, MD, PhD (Université de Lorraine, Nancy, France), calls the findings “concerning,” and notes that the suggestion that the rise in new HF cases stems from patients who have survived MI can be viewed as “an ironic success” if they are due to advances in coronary disease management. Conversely, they should be viewed as failures if they are instead the result of poor adherence to HF prevention strategies, including inadequate control of hypertension.

As to the conclusion that the burden of newly diagnosed HF is now similar to the annual incidence of the four most common cancers combined, Zannad suggests that perhaps the data “will stimulate change and encourage heart failure to be addressed as an equal priority with cancer.”

Sources
  • Conrad N, Judge A, Tran J, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet. 2017;Epub ahead of print.

  • Zannad F. Rising incidence of heart failure demands action. Lancet. 2017;Epub ahead of print.

Disclosures
  • Conrad and Rahimi report no relevant conflicts of interest.
  • Zannad reports steering committee fees from Janssen, Bayer, Pfizer, Novartis, Boston Scientific, Resmed, Takeda, General Electric, Boehringer Ingelheim, CVRx, and AstraZeneca; and consulting fees from Amgen, Quantum Genomics, Relypsa, AstraZeneca, Roche Diagnostics, and Vifor Fresenius.

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