3 May 2024 — Years of progress in lowering the death rate are being reversed as more Americans are passing away from heart failure today than they did in 1999.
The startling conclusion of a recent JAMA Cardiology study is that, compared to 25 years ago, the death rate from heart failure has increased by 3%. According to the study, the mortality rate decreased dramatically between 1999 and 2009, then plateaued for a few years before rising sharply between 2012 and 2019. The data came from death certificates. Heart failure mortality increased in the pandemic years of 2020 and 2021, the most recent year for which data is available.
Veronique Roger, MD, MPH, head of the National Heart, Lung, and Blood Institute’s epidemiology and community health section, called the statistics “striking.” “They truly represent a pressing request for action to buck this trend.”
Roger, who was not involved in the study, pointed out that the rise in heart failure-related deaths was mostly to blame for the fall in cardiovascular disease mortality throughout the 2000s and the subsequent leveling off of the rate. This essay demonstrates that not only are we not moving forward, but our successes are also being undermined. Thus, it’s quite important.
The National Institutes of Health estimates that 6.7 million Americans suffer from heart failure at this time. Of course, that’s just a moment in time: According to the NIH, almost 1 in 4 Americans will experience heart failure at some point in their lives. After being diagnosed, around half of persons who have the illness pass away in five years.
Individuals 65 years of age or older are significantly more likely than younger persons to die from heart failure. However, the study found that younger Americans had the greatest relative increase in the death rate. Heart failure fatalities increased ninefold among those under 45 and nearly fourfold among those between 45 and 64 between 2012 and 2021.
Heart Failure Is Caused by Comorbidities
According to Marat Fudim, MD, an associate professor of cardiology at Duke University in Durham, NC and co-author of the study, the rise in heart failure fatalities among younger people is likely due to the rising rates of obesity and diabetes among young adults. The fact that more and more people with these illnesses get heart failure in middle age is not surprising, he said.
Otherwise, he claimed, “men, women, and different races seem to have been affected in a very similar fashion by the reversal of [heart failure mortality] trends.” It did not distinguish between people of rural and urban areas in that way. Although heart failure death rates varied significantly between racial groups and between rural and urban areas, all of these groups showed a remarkably similar reversal trend.
“What we observe in clinical settings is that heart failure is primarily caused by comorbidities,” stated Fudim, who specializes in cardiology. Rarely is heart failure the result of a single illness. Patients with heart failure typically suffer from obesity, diabetes, hyperlipidemia, and cardiac artery disease; these conditions all contribute to heart failure and its subsequent death.
Heart failure mortality was already rising before the COVID-19 pandemic, but the virus quickened the rise in heart failure-related deaths. The average yearly percentage change in mortality from 2012 to 2019 was 1.82%; in 2020 and 2021, it increased to 7.06%.
According to Fudim, there are two causes for this. First, after controlling for their overall health, patients hospitalized for pneumonia associated to COVID-19 had a roughly 20% increased risk of having heart failure. Furthermore, COVID exacerbated racial and socioeconomic health inequities and caused the healthcare system to concentrate more on COVID-related treatment than on managing or preventing heart failure.
Factors Increasing the Mortality Rate
COVID was “like throwing fuel on the fire” of heart failure mortality, according to a co-author of a previous study that demonstrated an increase in the rate of heart failure deaths.
Sadiya S. Khan, MD, the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University’s Feinberg School of Medicine in Chicago, concurred that comorbidities that individuals acquired earlier in life are likely to be linked to the rise in middle-aged deaths from this illness. Khan expanded on the list of possible conditions linked to heart failure-related death to include kidney illness. She also mentioned that she is witnessing an earlier start of heart failure.
In a research report, Khan’s team demonstrated that while the death rate from heart failure increased, the mortality rate from ischemic heart disease, or hardening of the arteries, which frequently results in heart attacks, decreased. She primarily credits this to improved therapies for the underlying cardiac condition.
Effective therapy for ischemic heart disease have advanced significantly, especially in the areas of stenting, statin-based lipid-lowering medications, and certain novel therapeutics. For heart failure, the same advancements haven’t been observed.
The incidence of heart failure is another aspect that may have played a role in the higher death rate. More individuals will die from heart failure if it becomes more common. However, even in the absence of greater prevalence, Roger and Fudim noted that a higher death rate could come from heart failure patients being sicker than they were in the past. The heart failure rate is essentially flat but is progressively increasing, according to Fudim’s data.
Where Were We Mistaken?
According to Khan’s 2019 study, the early drop in fatalities from cardiovascular disease was likely caused by the effectiveness of policies meant to improve blood pressure and cholesterol control, as well as better rates of smoking cessation and appropriate medication use.
The study noted that “heart failure-related CVD mortality rates are rising, the prevalence of obesity and diabetes has increased dramatically, and the decline in overall CVD death rates has stalled.”
Given the abundance of appropriate actions taken, why did the trend in heart failure mortality reverse?
She believes the doctors are doing the right things, thus Roger is not to blame.
The thing we haven’t done well is manage diabetes and obesity. The decisions you and I and everyone else make when we eat are not made at the doctor’s office since diabetes travels with weight, Roger remarked.
“We’ve done the best we could with the things that we could control,” the woman remarked. “However, that is counteracted by the obesity trends, which are linked to the consumption of highly processed foods, beverages with added sugar, and other items.”
Fudim, on the other hand, thinks that the trend in heart failure mortality has reversed, at least in part, because of the health system. He claimed that access to care is restricted in many locations, prevention and chronic care are underemphasized, and some heart failure patients are not receiving the care they require, in part due to shortages in primary care.
Roger concurred. She stated that “difficulties in accessing the health care system and the quality of health care both play a role,” citing the significantly higher heart failure death rate among Black people as evidence.
However, she added that because of Medicare incentives, health systems have prioritized bettering the care of people with heart failure. She stated that the rising number of heart failure deaths in spite of all these efforts ought to serve as “an urgent wake-up call.” We can’t let this trend to continue as it is, so new directions in clinical treatment, preventive, and research should be combined to address or lessen it.