Trends In Heart Failure Mortality Research Articles

Catheter ablation of atrial arrhythmias in cardiac amyloidosis: Impact on heart failure and mortality.

Atrial arrhythmias (AA) commonly affect patients with cardiac amyloidosis (CA) and are a contributing risk factor for the development of heart failure (HF). This study sought to investigate the long-term efficacy and impact of catheter ablation on HF progression in patients with CA and AA. Thirty-one patients with CA and AA undergoing catheter ablation were retrospectively included (transthyretin-ATTR CA 61% and light chain-AL CA 39%). AA subtypes included atrial fibrillation (AFib) in 22 (paroxysmal in 10 and persistent in 12), atrial flutter (AFl) in 17 and atrial tachycardia (AT) in 11 patients. Long-term AA recurrence rates were evaluated along with the impact of sinus rhythm (SR) maintenance on HF and mortality. AA recurrence was observed in 14 patients (45%) at a median of 3.5 months (AFib n = 8, AT n = 6, AFl = 0). Post-cardioversion, medical therapy or catheter ablation, 10 patients (32%) remained in permanent AA. Over a median follow-up of 19 months, all-cause mortality was 39% (n = 12): 3 with end-stage HF, 5 due to late complications of CA, 1 sudden cardiac death, 1 stroke, 1 COVID 19 (and one unknown). With maintenance of SR following catheter ablation, significant reductions in serum creatinine and natriuretic peptide levels were observed with improvements in NYHA class. Two patients required hospitalization for HF in the SR maintenance cohort compared to 5 patients in the AA recurrence cohort (p = 0.1). All 3 patients with deaths secondary to HF had AA recurrence compared to 11 out of the 28 patients whom were long-term survivors or deaths not related to HF (p = 0.04). All-cause mortality was not associated with AA recurrence. This study demonstrates moderate long-term efficacy of SR maintenance with catheter ablation for AA in patients with CA. Improvements in clinical and biological status with positive trends in HF mortality are observed if SR can be maintained.

Trends in heart failure mortality in the USA 1999 to 2020

Abstract Background Heart failure (HF) is a complex clinical syndrome which is a public health challenge in the US. Despite advancements in HF treatment strategies the mortality reduction has been far from ideal. We aimed to study the trends of HF mortality stratified by race and gender from 1999 to 2020. Methods The CDC WONDER multiple cause of death dataset was used to analyze trends in mean age at death (MAD) and age adjusted mortality rate (AAMR, expressed per 100,000 persons) for patients dying from HF (underlying cause of death) and dying with HF (co-morbid HF) in the USA. Results From 1999 to 2020, the AAMR and MAD for patients dying from HF were 19.3 (Men, Women; 21.3, 17.7) and 83.2 (Men, Women; 85.3, 80.4; p <0.01). The AAMR and MAD for patients dying with HF were 72.4 (Men, Women; 85.8, 63.0) and 81.1 years (Men, Women; 83.2, 78.6; p <0.01). The AAMR and MAD remained stable in both genders between the years 1999 and 2020. The AAMR and MAD among White, Black and other race patients dying with HF were (73.3, 75.1, and 37.7; p<0.01) and (81.4, 74.0 and 79.8; p<0.01). The AAMR and MAD among White, Black and other race patients dying from HF were (20.2, 22.5, and 8; p<0.01) and (84, 76.1 and 85.1; p<0.01). While there was no statistically significant change in AAMR and MAD among persons dying from HF, there was a significant decline in AAMR among persons dying with HF with an AAPC of -0.5(-0.8 to -0.1). Black patients witnessed a statistically significant decline in MAD from 77.8 in 1999 to 74.3 in 2020, MAD remained stable in Whites and Other Races. Conclusion Despite advances in guideline directed medical therapy with proven mortality benefit for management of heart failure, the nationwide HF mortality trend has plateaued. Racial disparities with higher HF related mortality in Black patients continue to exist. Therefore, systemic efforts are needed to optimize the HF outcomes by optimizing the preventive and treatment strategies of HF.

Temporal trends in heart failure mortality in an integrated healthcare delivery system, California, and the US, 2001\u20132017

BackgroundIn recent years, decreases in mortality rates attributable to cardiovascular diseases have slowed but mortality attributable to heart failure (HF) has increased.MethodsBetween 2001–2017, trends in age-adjusted mortality with HF as an underlying cause for Kaiser Permanente Southern California (KPSC) members were derived through linkage with state death files and compared with trends among California residents and the US. Average annual percent change (AAPC) and 95% confidence intervals (CI) were calculated using Joinpoint regression. Analyses were repeated examining HF as a contributing cause of death.ResultsIn KPSC, the age-adjusted HF mortality rates were comparable to California but lower than the US, increasing from 23.9 per 100,000 person-years (PY) in 2001 to 44.7 per 100,000 PY in 2017, representing an AAPC of 1.3% (95% CI 0.0%, 2.6%). HF mortality also increased in California 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%). Trends among KPSC members ≥ 65 years old were similar to the overall population, while trends among members 45–64 years old were flat between 2001–2017. Small changes in mortality with HF as a contributing cause were observed in KPSC members between 2001 and 2017, which differed from California and the US.ConclusionLower rates of HF mortality were observed in KPSC compared to the US. Given the aging of the US population and increasing prevalence of HF, it will be important to examine individual and care-related factors driving susceptibility to HF mortality.

Geographic Variation in Trends and Disparities in Heart Failure Mortality in the United States, 1999 to 2017.

BackgroundCardiovascular disease mortality related to heart failure (HF) is rising in the United States. It is unknown whether trends in HF mortality are consistent across geographic areas and are associated with state‐level variation in cardiovascular health (CVH). The goal of the present study was to assess regional and state‐level trends in cardiovascular disease mortality related to HF and their association with variation in state‐level CVH.Methods and ResultsAge‐adjusted mortality rates (AAMR) per 100 000 attributable to HF were ascertained using the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research from 1999 to 2017. CVH at the state‐level was quantified using the Behavioral Risk Factor Surveillance System. Linear regression was used to assess temporal trends in HF AAMR were examined by census region and state and to examine the association between state‐level CVH and HF AAMR. AAMR attributable to HF declined from 1999 to 2011 and increased between 2011 and 2017 across all census regions. Annual increases after 2011 were greatest in the Midwest (β=1.14 [95% CI, 0.75, 1.53]) and South (β=0.96 [0.66, 1.26]). States in the South and Midwest consistently had the highest HF AAMR in all time periods, with Mississippi having the highest AAMR (109.6 [104.5, 114.6] in 2017). Within race‒sex groups, consistent geographic patterns were observed. The variability in HF AAMR was associated with state‐level CVH (P<0.001).ConclusionsWide geographic variation exists in HF mortality, with the highest rates and greatest recent increases observed in the South and Midwest. Higher levels of poor CVH in these states suggest the potential for interventions to promote CVH and reduce the burden of HF.

Changing Spatiotemporal Trends in County-Level Heart Failure Death Rates in the United States, 1999 to 2018.

BackgroundAmid recently rising heart failure (HF) death rates in the United States, we describe county‐level trends in HF mortality from 1999 to 2018 by racial/ethnic group and sex for ages 35 to 64 years and 65 years and older.Methods and ResultsApplying a hierarchical Bayesian model to National Vital Statistics data representing all US deaths, ages 35 years and older, we estimated annual age‐standardized county‐level HF death rates and percent change by age group, racial/ethnic group, and sex from 1999 through 2018. During 1999 to 2011, ~30% of counties experienced increasing HF death rates among adults ages 35 to 64 years. However, during 2011 to 2018, 86.9% (95% CI, 85.2–88.2) of counties experienced increasing mortality. Likewise, for ages 65 years and older, during 1999 to 2005 and 2005 to 2011, 27.8% (95% CI, 25.8–29.8) and 12.6% (95% CI, 11.2–13.9) of counties, respectively, experienced increasing mortality. However, during 2011 to 2018, most counties (67.4% [95% CI, 65.4–69.5]) experienced increasing mortality. These temporal patterns by age group held across racial/ethnic group and sex.ConclusionsThese results provide local context to previously documented recent national increases in HF death rates. Although county‐level declines were most common before 2011, some counties and demographic groups experienced increasing HF death rates during this period of national declines. However, recent county‐level increases were pervasive, occurring across counties, racial/ethnic group, and sex, particularly among ages 35 to 64 years. These spatiotemporal patterns highlight the need to identify and address underlying clinical risk factors and social determinants of health contributing to these increasing trends.

Use of Google Trends as a Novel Epidemiological Tool

Introduction Heart Failure (HF) is an important healthcare issue with wide ranging impacts. Traditional census and epidemiological tools do not adequately address the need for dynamic quantification of disease burden. Analysis of Google search data using Google Trends (GT) can offer dynamic digital insight into epidemiology of heart disease. Hypothesis GT data for HF mirror the trends of HF mortality across the country. It can also be used to detect the efficacy of public outreach program such as Heart Failure Awareness Week (HFAW) in capturing public interest and raising awareness about the disease. Methods GT data (reported as Search Volume Index [SVI]) from 2005-2018 for HF were obtained from Google Trends website. HF age adjusted mortality rates (AAMR) data were obtained from CDC wonder website. JoinPoint regression model was used to analyze temporal trends in HF mortality from 2005-2018. Quadratic regression model was used to analyze association between HF mortality and GT data. One way ANOVA test followed by Tukey post hoc test was used to find differences between monthly GT data. Results Heart failure AAMR decreased significantly during 2005-2011 at an annual percentage change of -2.52 (95%CI: -3.85- -1.17). AAMR increased significantly during the next period 2011-2016 at an APC of 3.51 (95%CI: 2.49 - 4.54). (Figure 1a) These trends had strong positive correlation with the GT data for HF (R = 0.875, p Conclusions GT data mirror the national trends of HF mortality. Google searches for HF were significantly higher in states that had higher HF mortality. GT data can also be used to assess the efficacy of public outreach program such as HFAW. Thus, it can be concurred that GT is an effective and indispensable epidemiological tool that is not currently being used to its potential.

National trends in heart failure mortality in men and women, United Kingdom, 2000-2017.

AimsTo understand gender differences in the prognosis of women and men with heart failure, we compared mortality, cause of death and survival trends over time.Methods and resultsWe analysed UK primary care data for 26 725 women and 29 234 men over age 45 years with a new diagnosis of heart failure between 1 January 2000 and 31 December 2017 using the Clinical Practice Research Datalink, inpatient Hospital Episode Statistics and the Office for National Statistics death registry. Age‐specific overall survival and cause‐specific mortality rates were calculated by gender and year. During the study period 15 084 women and 15 822 men with heart failure died. Women were on average 5 years older at diagnosis (79.6 vs. 74.8 years). Median survival was lower in women compared to men (3.99 vs. 4.47 years), but women had a 14% age‐adjusted lower risk of all‐cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84–0.88]. Heart failure was equally likely to be cause of death in women and men (HR 1.03, 95% CI 0.96–1.12). There were modest improvements in survival for both genders, but these were greater in men. The reduction in mortality risk in women was greatest for those diagnosed in the community (HR 0.83, 95% CI 0.80–0.85).ConclusionsWomen are diagnosed with heart failure older than men but have a better age‐adjusted prognosis. Survival gains were less in women over the last two decades. Addressing gender differences in heart failure diagnostic and treatment pathways should be a clinical and research priority.

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

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 &gt; 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.

Trends in heart failure mortality in Poland between 1980 and 2010

Data regarding standardized trends in mortality from heart failure (HF) in the general population are limited. The aim of the study was to evaluate trends in HF mortality in Poland in the years 1980-2010. An analysis of a database of mortality records from 1980-2010 based on National Statistics was performed. Mortality trends for HF by age and sex were analyzed by polynomial or linear regression. Total crude numbers of HF deaths in 1980 were 21,519 and 23,008 for women and men, respectively, whereas, in 2010, there were 23,304 and 19,558. There was a significant change in mortality trends for HF, from a decline during the first phase of the study to an increase during the most recent years, 2005-2010 (P <0.005 for changes of trends for both sexes). The lowest value reached in 2005 constituted 47% and 41% of the baseline for women and men, respectively. These ratios increased to 59% and 52% in 2010. Stratification by age and sex brought similar results, with the exception of the youngest groups, which showed initial increases in the rates for the years 1980-1985. There was a significant decline in the rates of HF mortality in the Polish population for both men and women, showing a maximal reduction of about 50% around 2005. However, between 2005 and 2010, a significant increase in the rates of HF mortality was observed (crude difference equaled 12% for women and 11% for men). It is unknown whether this is a temporary or permanent trend, and the issue requires further investigation.

Is it going to be only worse now - 30 years follow up of mortality trends of heart failure mortality in Poland

Background: Heart Failure (HF) mortality is still an important problem in European countries. Although in many of them substantial improvement have been noticed over last decades, but there are some premises showing a beginning of unfavorable trend in the last years. The aim of the study was to evaluate the mortality trends in Polish population for the years 1980-2010. Methods: All the data regarding number and causes of death was obtained. With regard to cause of death, we used only data with HF codes as the underlying reason of the event (for the years 1980-1996 - IX Revision; years 1997-2010 - X Revision). Presented data were standardized by European standardization mode per 100000 population. For the purpose of the analysis we limited age of subject to least 45 years of age. Results: Total crude mortality rates for heart failure in 1980 were 21519 and 23008 respectively for women and men, whereas for year 2010 numbers were 23304 and 19558. Age standardized rates per 100000 inhabitants for years 1989-2010 for every 5 years period are presented in the table. There was a significant change in HF mortality trends from decline during the first phase of the study with increasing trends during the last years of observations (p< 0.005 for change of trends for both men and women). The lowest value reached (in 2005) constituted 47% and 41% of baseline numbers for women and men respectively, however climbing up to 59% and 52% by year 2010. Stratification by age groups for both genders brought alike results, with the exception for the youngest groups which showed initial increase in rates for the years 1980-1985. View this table: HF Mortality per 100000 population Conclusion: There was a significant decline in the rates of HF mortality in Polish population for both men and women, showing a maximal reduction of about 50% around year 2005. However during the last 5 years of observation significant increase in HF mortality rates is noticeable with narrowing the gap between men and women. It is unknown if it is a temporal of permanent trend and requires further observation.

Trends in heart failure mortality in England and Wales since 1950

Background This study aims to analyse trends in heart failure mortality for England and Wales from 1950 to 2003. Methods A retrospective observational study was conducted using death certificate and population data from the Office for National Statistics. Results Unadjusted heart failure deaths rose by a factor of more than four between 1950 and 1974 and then fell by a quarter by 2003. When standardised for changes in the age, sex and size of the population, there was a tripling in mortality rate from 1950 to the mid-1970s and since then, a sustained decline in mortality rate of 50% by 2003. The unadjusted female heart failure death rate has been between 1.5–2 times that of males since the early 1970s, but this is much less marked when the differences in the age distribution and sizes of the male and female populations are taken into account. Heart failure mortality trends are similar to those of coronary heart disease (CHD), but the peak is about 10 years earlier, and the male/female ratios are reversed. There is a continuing rise in deaths from both heart failure and CHD in the very elderly (> 85 years). Conclusion Unlike hospital trends, deaths from heart failure in the community in England and Wales show a decline since the early 1970s, in spite of an ageing population. This may reflect genuine changes in heart failure incidence, or parallel changes in CHD.