By Ray Hainer
SUNDAY, Nov. 9, 2008 (Health.com) — Heart failure, a chronic condition in which the heart struggles to pump enough blood, has risen dramatically in the United States in the past 30 years, according to a study presented Sunday at the American Heart Association (AHA) meeting in New Orleans.
One reason is that people are living longer after heart attacks or with heart disease, two conditions that can lead to a weaker heart muscle. "Second, we have a huge aging population now," says study author Longjian Liu, MD, PhD, an associate professor of epidemiology and biostatistics at the Drexel University School of Public Health in Philadelphia.
Unlike coronary heart disease, in which a clogging of the arteries can cause heart attacks in relatively young people, heart failure is typically an older person's affliction. Its prevalence increases sharply after age 60, and it is the leading cause of hospitalization among people on Medicare.
Heart failure will become an even more pressing problem as the baby-boom generation continues to age. By 2030, the number of Americans over the age of 65 is expected to double to more than 70 million, and Dr. Liu expects heart failure to reach epidemic levels.
"We have to recognize that heart failure will get worse," he says. "I don't think at this stage that we can stop it immediately, because of the aging population." He also says that the number of overweight and obese people will continue to increase, adding to the problem.
Overall, heart failure hospitalizations more than doubled between 1980 and 2006, from nearly 350,000 to more than 800,000. Among men, the hospitalization rates rose from 16.6 per 1,000 to nearly 23 per 1,000.
While women had lower annual rates—roughly 20 women per 1,000 were diagnosed with heart failure in 2006—the total rate increase among women outpaced that among men (a 55% rise compared to 20% in men.)
More than five million Americans are currently living with the chronic condition. As heart failure progresses, the heart muscle becomes progressively weaker and larger, fluid builds up in the lungs and limbs, and people feel short of breath and experience extreme fatigue among other symptoms.
Dr. Liu and his colleagues examined data from more than 2.2 million patients over the age of 65 who were discharged from a hospital between 1980 and 2006. They discovered the marked increase in heart failure diagnoses, which occurred as coronary heart disease and stroke hospitalizations declined.
The findings suggest that heart failure prevention and treatment have not kept up with those of other cardiovascular diseases, according to Gregg Fonarow, MD, codirector of the preventative cardiology program at UCLA.
The skyrocketing use of cholesterol-lowering statins for heart disease, for example, has translated into fewer repeat heart attacks and hospitalizations. However, the same can't be said of medications that can help prevent heart failure, says Dr. Fonarow.
"There remain large numbers of eligible patients who are not receiving one or more of the therapies that are recommended in national guidelines, and as a consequence they face higher hospitalization and mortality rates than they need to," says Dr. Fonarow, who coauthored a 2008 AHA statement on heart failure prevention.
At-risk patients should be monitored and treated, according to the guidelines issued by the AHA and the American College of Cardiology. They recommend that people who have no heart failure symptoms, but do have structural abnormalities in their hearts, should in some cases be prescribed medications such as ACE inhibitors.
Dr. Liu's data should serve as a warning that the prevention and treatment of heart failure needs to improve, says Dr. Fonarow.
"It is striking that, despite having very effective therapies that have been proven to reduce the risk of hospitalization and mortality, there's still a substantial proportion of patients who could benefit from those treatments who are not receiving them due to oversights and unreliable care," he says. "A concerted, focused, and comprehensive effort to improve the quality of care and outcomes for patients with heart failure is urgently needed."
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