Abstract 270: Temporal Trends in Heart Failure Mortality in an Integrated Healthcare Delivery System, California and the US, 2001-2017

Abstract

Background: In recent years declines in the rate of mortality attributable to cardiovascular diseases have slowed and mortality attributable to heart failure (HF) has increased. Objective: To examine secular trends in mortality with HF as the underlying cause in Kaiser Permanente Southern California (KPSC), California, and the US among adults 45 years of age and older from 2001 and 2017. Methods: KPSC mortality rates with HF as an underlying cause from 2001 to 2017 were derived through linkage with California State death files and were compared with rates in California and the US. Rates were age-standardized to the 2000 US Census population. Trends were examined overall and among men and women, separately, using best-fit Joinpoint regression models. Average annual percent change (AAPC) and 95% confidence intervals (CI) were calculated for the overall study period, and within earlier (2001-2011) and later (2011-2017) time periods. Results: Between 2001-2017, age-adjusted mortality rates with HF as the underlying cause were lower comparing KPSC to California and the US. In KPSC, rates increased from 23.9 to 44.7 per 100,000 person-years (PY) in KPSC, representing an AAPC of 1.3% (95% CI 0.0%, 2.6%). (Table) During the same time period, HF mortality rates in California also increased from 33.9 to 46.5 per 100,000 PY (AAPC 1.5%, 95% CI 0.3%, 2.7%), while remaining unchanged in the US at 57.9 per 100,000 PY in 2001 and 2017 (AAPC 0.0%, 95% CI -0.5%, 0.5%). AAPCs were not statistically different comparing KPSC to both California and the US (all p > 0.05). Between 2001-2011, rates of HF mortality increased in KPSC (AAPC 1.3%, 95% CI 0.0, 2.6), non-significantly increased in California (AAPC 0.2%, 95% CI -0.8%, 1.2%) and decreased in the US (AAPC -2.1%, 95% CI -2.7%, -1.5%). Between 2011-2017, rates of HF mortality increased in KPSC (AAPC 1.3%, 95% CI 0.0%, 2.6%), California (AAPC 3.7%, 95% CI 1.0%, 6.5%), and the US (AAPC 3.6%, 95% CI 2.4%, 4.8%) except among KPSC women (AAPC 0.3% [95% CI -1.6%, 2.2%]). Conclusion: Despite increases in HF mortality after 2011, rates of HF mortality were lower among KPSC compared to California and the US. Given the mortality burden of HF at older age, there is a need to improve HF prevention, treatment and management efforts earlier in life.