The Socio-Geography of Heart Failure

Abstract

Morbidity and mortality rates from heart failure are staggering and continue to pose daunting challenges to patients, providers, researchers, and the health care system. As populations age, the increasing burden of cardiovascular disease portends a humbling future, particularly for heart failure. Despite advances in medical care, heart failure prevalence, hospitalizations, and mortality rates have not declined; in 2007, more than 250 000 Americans died of heart failure, and the number of heart failure hospitalizations has tripled from about 1.3 million in 1979 to nearly 4 million in 2004.1,2 The burden of heart failure admissions and frequent readmissions are also costly to the health care system. Corresponding to the projected increase in heart failure prevalence, real medical costs for heart failure are projected to increase by ≈200% over the next 20 years.3 Articles see p 308 and 317 Reports from the Agency for HealthCare Research and Quality (AHRQ) recognize geographic variation in heart failure hospitalizations.4 Regional variations have been associated with number of primary care physicians per population, regional income level, and the proportion of Medicare payment.5 The mere presence of this variation implies that some, maybe even most, heart failure rehospitalizations are avoidable. Potential contributors to admission may include barriers at the system or individual level such as difficulties accessing primary or outpatient medical care services, poor quality of this care when accessed, or lack of patient adherence.5 However, optimal outpatient care may reduce avoidable hospitalizations and medical expenditures and improve quality of life, suggesting a potential opportunity.5 ### Geography Matters In this issue of Circulation: Heart Failure , two reports highlight associations of geography with heart failure service utilization and outcomes, …