Author + information
- Received January 2, 2018
- Revision received March 9, 2018
- Accepted March 13, 2018
- Published online July 30, 2018.
- Connie W. Tsao, MD, MPHa,b,c,∗ (, )
- Asya Lyass, PhDc,d,
- Danielle Enserro, PhDd,e,
- Martin G. Larson, ScDc,d,
- Jennifer E. Ho, MDb,f,
- Jorge R. Kizer, MD, MScg,h,
- John S. Gottdiener, MDi,
- Bruce M. Psaty, MD, PhDj,k and
- Ramachandran S. Vasan, MDc,l
- aCardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- bHarvard Medical School, Boston, Massachusetts
- cBoston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts
- dDepartment of Mathematics and Statistics, Boston University, Boston, Massachusetts
- eRoswell Park Cancer Institute, Buffalo, New York
- fDivision of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- gDivision of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- hDepartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- iDivision of Cardiology, Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland
- jCardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington
- kGroup Health Research Institute, Group Health Cooperative, Seattle, Washington
- lSections of Cardiology and Preventative Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Connie W. Tsao, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215.
Objectives This study aimed to determine temporal trends in the incidence of and mortality associated with heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart rate with preserved ejection fraction [HFpEF]) in the community.
Background Major shifts in cardiovascular disease risk factor prevalence and advances in therapies may have influenced HF incidence and mortality.
Methods In the FHS (Framingham Heart Study) and CHS (Cardiovascular Health Study), for participants who were ≥60 years of age and free of HF (n = 15,217; 60% women; 2,524 incident HF cases; 115,703 person-years of follow-up), we estimated adjusted incidence rate ratios of HF, HFrEF, and HFpEF from 1990 to 1999 and 2000 to 2009. We compared the cumulative incidence of and mortality associated with HFrEF versus HFpEF within and between decades.
Results Across the 2 decades, HF incidence rate ratio was similar (p = 0.13). The incidence rate ratio of HFrEF declined (p = 0.0029), whereas HFpEF increased (p < 0.001). Although HFrEF incidence declined more in men than in women, men had a higher incidence of HFrEF than women in each decade (p < 0.001). The incidence of HFpEF significantly increased over time in both men and women (p < 0.001 and p = 0.02, respectively). During follow-up after HF, 1,701 individuals died (67.4%; HFrEF, n = 557 [33%]; HFpEF, n = 474 [29%]). There were no significant differences in mortality rates (overall, cardiovascular disease, and noncardiovascular disease) across decades within HF subtypes or between HFrEF and HFpEF within decade.
Conclusions In several U.S. community–based samples from 1990 to 2009, we observed divergent trends of decreasing HFrEF and increasing HFpEF incidence, with stable overall HF incidence and high risk for mortality. Our findings highlight the need to elucidate factors contributing to these observations.
This study was supported by grants from the National Institutes of Health (NIH) N01-HC-25195 and HHSN268201500001I to the Framingham Heart Study/Boston University School of Medicine; and the Cardiovascular Health Study (CHS) is supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grants U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. Dr. Tsao has received grant K23 HL118529 from the NIH. Dr. Ho received grant K23 HL116780 from the NIH. Dr. Kizer has stock ownership in Pfizer, Gilead Sciences, and Johnson & Johnson. Dr. Psaty was on the Data and Safety Management Board of Zoll LifeCor; and has served on the steering committee of Yale Open Access Project funded by Johnson & Johnson. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 2, 2018.
- Revision received March 9, 2018.
- Accepted March 13, 2018.
- 2018 American College of Cardiology Foundation