JMIR Publications

ABSTRACT

Objectives: Heart failure (HF) is a challenging clinical and public health problem characterized by high prevalence and mortality among US older adults. Recent decline in HF prevalence and increase in mortality require research to investigate the relative contributions of their epidemiologic determinants in the respective HF trends. Study design: Secondary data analysis of the 5% Medicare Claim data for 1992-2017.

Methods:

Age-adjusted prevalence and incidence-based mortality (IBM) were partitioned into their respective epidemiologic determinants using the partitioning analysis approach.

Results:

Partitioning of HF prevalence showed three phases: (a) Decelerated Increasing Prevalence (DIP) (1994-2006), (b) Accelerated Declining Prevalence (ADP) (2007-2014), and (c) Decelerated Declining Prevalence (DDP) (2015-2017). During the whole period, the decreasing HF incidence contributed to the declines in prevalence, overpowering prevalence increases contributed from survival. Likewise, partitioning of HF IBM showed three phases: (a) Decelerated Increasing Mortality (DIM) (1994-2001), (b) Accelerated Declining Mortality (ADM) (2002-2012), and (c) Decelerated Declining Mortality (DDM) (2013-2017). The decreasing HF incidence in 1994-2017 and increasing survival in 2002-2006 contributed to the declines in mortality, while the decreasing survival in 2007-2017 contributed to the mortality increase.

Conclusions:

Decade-long declines in HF prevalence and mortality mainly reflected decreasing disease incidence, while the most recent increase of mortality was predominantly due to the declining survival. If current trends persist, HF prevalence and mortality are forecasted to grow substantially in the next decade. Prevention strategies should continue the prevention of HF risk factors with a primary focus on the improvement of treatment and management of HF after diagnosis.