Incidence and prevalence of heart failure in elderly persons, 1994-2003

Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Durham, NC 27715, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 03/2008; 168(4):418-24. DOI: 10.1001/archinternmed.2007.80
Source: PubMed


Recent analyses have presented conflicting evidence regarding the incidence and prevalence of heart failure in the United States. We sought to estimate the annual incidence and prevalence of heart failure and associated survival in elderly persons from January 1, 1994, through December 31, 2003.
We conducted a retrospective cohort study of 622,789 Medicare beneficiaries 65 years or older who were diagnosed as having heart failure between 1994 and 2003. The main outcome measures were incidence and prevalence of heart failure and survival following a heart failure diagnosis.
The incidence of heart failure declined from 32 per 1000 person-years in 1994 to 29 per 1000 person-years in 2003 (P < .01). Incidence declined most sharply among beneficiaries aged 80 to 84 years (from 57.5 to 48.4 per 1000 person-years, P < .01) and increased slightly among beneficiaries aged 65 to 69 years (from 17.5 to 19.3 per 1000 person-years, P < .01). Although risk-adjusted mortality declined slightly from 1994 to 2003, the prognosis for patients diagnosed as having heart failure remains poor. In 2002, risk-adjusted 1-year mortality was 27.5%, more than 3 times higher than for age- and sex-matched patients.
Although the incidence of heart failure has declined somewhat during the past decade, modest survival gains have resulted in an increase in the number of patients living with heart failure. Identifying optimal strategies for the treatment and management of heart failure will become increasingly important as the size of the Medicare population grows.

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    • "Chronic heart failure (CHF) is a very common condition in the aged population, with a prevalence of up to 12%.1 It is characterized by high mortality, which reaches 50% in the 5 years following diagnosis.2 "
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    ABSTRACT: Chronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong impact on health-related quality of life (HRQOL). Previous studies of HRQOL in elderly heart failure subjects have included mostly outpatients, and little is known about determinants of HRQOL in hospitalized elderly population, especially in Serbia. In this study, we tried to identify factors that influence HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. The study population consisted of 136 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis. Univariate analysis showed that patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Presence of depressive symptoms (P<0.001), higher NYHA class (P=0.021), lower income (P=0.029), and longer duration of heart failure (P=0.049) were independent predictors of poor HRQOL. Depressive symptoms, higher NYHA class, lower income, and longer duration of chronic heart failure are independent predictors of poor HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Further, there is an association between multiple medication usage and poor HRQOL, as well as a negative impact of cognitive impairment on HRQOL. Hence, measures should be implemented to identify such patients, especially those with depressive symptoms, and appropriate interventions undertaken in order to improve their HRQOL.
    Clinical Interventions in Aging 11/2013; 8:1539-1546. DOI:10.2147/CIA.S53305 · 2.08 Impact Factor
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    • "Atrial fibrillation (AF) and heart failure (HF) are important cardiac disorders and the prevalence of both is increasing [1] [2] [3]. Atrial fibrillation can worsen HF or lead to this condition through tachycardia-mediated cardiomyopathy [4] [5] [6] [7], and patients with HF have increased risk for atrial fibrillation [8]. "
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    ABSTRACT: Atrial fibrillation (AF) is a common arrhythmia that can promote or worsen heart failure (HF). Our purpose was to compare the effects of rate and rhythm control in patients with atrial fibrillation and heart failure. We developed a systematic search in August 2010 through CENTRAL and MEDLINE databases to identify randomised controlled trials (RCTs) comparing rate control with rhythm control in patients with both AF and HF. We analysed mortality, hospitalisations, stroke/thromboembolic events, quality of life, and drugs adverse events. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated for mortality and hospitalisations. The remaining outcomes were analysed qualitatively. Four RCTs with a total of 2486 patients with atrial fibrillation and heart failure were identified. Mortality and stroke/thromboembolic events were not significantly different in rate and rhythm control arms [RR 1.03; 95% CI: 0.90-1.17] and [RR 1.09; 95% CI: 0.61-1.96], respectively. Hospitalisations were less frequent with rate control than with rhythm control [RR 0.92; 95% CI: 0.86-0.98; p=0.008], in 3 studies involving 2425 patients. Number needed to treat to prevent one hospitalisation was 19 patients. In patients with AF and HF, rate control compared with rhythm control showed inferior risk of hospitalisation.
    European Journal of Internal Medicine 10/2011; 22(5):448-55. DOI:10.1016/j.ejim.2011.05.001 · 2.89 Impact Factor
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    • "Heart failure (HF) is a chronic condition associated with high mortality rates, frequent hospitalizations, and poor quality of life (QOL) [1] [2] [3]. Caregivers (CG) of HF patients are a key factor in helping patients perform self-care behaviours to avoid HF decompensation and take on new roles to compensate for the patient's functional decline [4] [5] [6]. "
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    ABSTRACT: Evidence suggests that caregivers of people with heart failure (HF) often experience caregiver burden and emotional distress. However, these studies measured the caregiving experience using generic tools since a disease-specific tool was not available. Recently, the Dutch Objective Burden Inventory (DOBI) was developed as a disease-specific tool measuring objective caregiver burden in a Dutch HF population of caregivers. Using a cross-sectional design, caregivers of HF patients attending an outpatient HF clinic completed the DOBI, the Hosptial Anxiety and Depression Scale (HADS) and the Caregiver Reaction Assessment (CRA). Caregivers (n=47) were mainly female (72%) and spouses (72%) of the HF patients with a mean age of 63.1 (±10.4) years. Patients were older (mean age 72.7; ±10.6), 64% male and had advanced HF. Feasibility for the objective portion of the DOBI was excellent with <10% missing values. The subjective component of the DOBI was incomplete and could not be used in the analyses. Seven items had minimal variability. Significant relationships emerged between the DOBI, CRA and HADS revealing construct validity for all subscales of the DOBI. Cronbach's alpha was >.80 for all DOBI subscales. The DOBI is the only disease-specific tool that measures burden for caregivers of HF patients. The objective portion of the DOBI showed evidence of adequate internal consistency and construct validity in a Canadian population of caregivers of HF patients attending a HF Clinic. Further testing is needed to determine floor and ceiling effects for DOBI items and responsiveness of this tool.
    European Journal of Cardiovascular Nursing 10/2010; 10(4):234-40. DOI:10.1016/j.ejcnurse.2010.08.006 · 1.88 Impact Factor
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