Heart failure hospitalization rates rise among nation's seniors

Heart failure is reaching epidemic levels among seniors in the United States, according to research presented at the American Heart Association's Scientific Sessions 2008.

"Both the number of patients hospitalized with a primary diagnosis of heart failure and age-adjusted hospitalization rates for heart failure have increased dramatically over the past 27 years," said Longjian Liu, M.D., Ph.D., M.Sc., author of the study, associate professor of Epidemiology and Biostatistics of the Drexel University School of Public Health in Philadelphia, Pa. "The prevention and treatment of heart failure has become an urgent public health need with national implications."

A chronic disease, heart failure occurs when any part of the heart muscle weakens and the heart can't supply the body's cells with enough oxygen and nutrient-rich blood. Everyday activities can become very difficult due to fatigue and shortness of breath. An estimated 5.3 million Americans live with heart failure, and 660,000 new cases are diagnosed each year, according to the American Heart Association.

Liu's study is the first to examine the disease's hospitalization rates over the last 27 years and is the initial portion of a serial report on heart failure epidemiology in the United States.

This study used data from more than 2.2 million patients (age 65 or older) in the National Hospital Discharge Surveys between 1980 and 2006. This national representative survey provides annual estimates of hospital discharges in the United States. In the study, heart failure was defined as patients with a primary diagnosis of heart failure at hospital discharge. This study broke the data down into three age groups: 65, 75 and 85 or older by gender, and then estimated statistically the hospitalization rates with census population data in terms of gender and time periods.

He found the following:

• The estimated number of patients age 65 and older who were hospitalized for heart failure increased from 348,866 in 1980 to 807,082 in 2006 – a 131 percent increase.
• For men, rates rose from 16.57 hospitalizations per 1,000 members of the population in 1980 to 22.87 in 2006.
• For women, rates rose from 13.95 hospitalizations per 1,000 members of the population to 19.58 in 2006.
• Women had a significantly higher annual percentage increase rate than men (55 percent vs. 20 percent).
• From 2002-2006, the relative risk of being hospitalized due to heart failure was 1.37 times higher than it had been from 1980-84.
• Patients ages 75-84 had twice the risk of being hospitalized for heart failure than those 65-74 those age 85 or older had four times more risk of hospitalization for heart failure than those ages 65-74.

The study also showed that, among the three major forms of cardiovascular disease, coronary heart disease and stroke have shown decreases in hospitalization rates since the mid-1980s. However, heart failure has shown a continuously significant increase in hospitalization rates since 1980.

Directly and indirectly, heart failure is expected to cost $34.8 billion in the United States this year, according to American Heart Association data. The peak of the crisis is still to come, Liu said.

"Over the next decades, the number of U.S. adults age 65 and older will double to a projected 70 million, and more than one in five will be 65 or older by the year 2030," he said. "Because heart failure disproportionately affects the elderly, there is no doubt that the burden of heart failure will increase unless innovative strategies are implemented. The key is to prevent risk factors for the disease."

These risk factors include high blood pressure, coronary heart disease, chronic obstructive pulmonary disease, valvular heart disease, diabetes, stroke, obesity and lifestyle risk factors such as smoking, physical inactivity and fatty food intake. Efforts also should be made to prevent chronic kidney disease and pneumonia as they contribute to heart failure as well, Liu said.