Abstract 18103: Community Trends in Incidence and Mortality of Hospitalized Acute Decompensated Heart Failure: The ARIC Study

Abstract

Introduction: Understanding population-based trends in heart failure incidence is important to evaluation and planning of prevention and treatment strategies. Hypothesis: Community trends of acute decompensated heart failure (ADHF) in racially diverse populations may differ by race and sex. Methods: The Atherosclerosis Risk in Communities (ARIC) Study conducted continuous and comprehensive surveillance of hospitalized ADHF events (age ≥55 years) in four US communities between 2005-2012 and estimated hospitalized ADHF incidence and survival by race and sex. 17,651 hospitalizations for ADHF were identified by ICD-9-CM codes, then validated by standardized physician review of hospital records, yielding a weighted sample of 31,006 hospitalizations after accounting for sampling design. HF with reduced EF (HFrEF) was defined as EF<50%. Results: Of the ADHF hospitalizations, 16259 (52.4%) were HFrEF, 11835 (38.2%) were HF with preserved EF (HFpEF), and 2912 (9.4%) were HF with unknown EF. HFrEF (both incident and recurrent ADHF) was more common in men (black men 70.4%, white men 61.4%), whereas HFpEF was more common in women (white women 50.0%, black women 39.5%). Compared to whites, blacks were younger, with less coronary heart disease and atrial arrhythmias, and more hypertension, diabetes, and chronic kidney disease. Between 2005-2012, the incidence of hospitalized ADHF increased, which mostly reflected the increase in rates of HFpEF (average annual percent change of incident HFpEF: black women 16.6%, black men 13.2%, white women 8.0%, white men 8.3%), with higher age-adjusted average incident HFpEF rates in women (black women 6.2 per 1000 persons, white women 5.9/1000, black men 4.6/1000, white men 4.2/1000). Changes in HFrEF incidence and changes in 28-day and 1-year case fatality for HFpEF and HFrEF were modest and generally not statistically significant. Age-adjusted 1-year case fatality was similar across all race-sex groups (~30% after any incident ADHF). Similar trends were seen for recurrent ADHF (HFpEF and HFrEF). Conclusions: Incident ADHF rates increased between 2005 and 2012 in the ARIC Study communities, primarily because of incident HFpEF in women and blacks. Further study is needed to understand the differences by race and sex.