Deaths From Heart Failure Climbing Rapidly as Elderly Population Expands

October 30, 2019

Recent declines in the number of deaths from heart disease in the United States have reversed since about 2011 in large part because the susceptible 65-and-older age group is expanding far faster than the ranks of younger people, a new analysis suggests.

As the older population accounts for most such mortality, their disproportionately rapid growth has led to a "steady, substantial increase" in overall number of heart disease deaths, conclude researchers in a report published online October 30 in JAMA Cardiology.

Deaths from heart failure (HF), second only to coronary heart disease (CHD) as a cause of heart disease mortality, also occur predominantly in the elderly and have been climbing sharply in recent years.

"It's the dynamics of the overall population growth that are causing the number of heart disease deaths to increase, and the number of heart failure deaths to increase at a startlingly high rate," lead author Stephen Sidney, MD, MPH, Kaiser Permanente Northern California, Oakland, told | Medscape Cardiology.

"Most heart disease deaths occur in older people," he observed, noting that about 80% of all heart disease deaths and more than 90% of deaths from HF were in people 65 years and older. And that age group is growing five times faster than the general population, Sidney said.

He and his colleagues looked at trends in the United States from 2011 to 2017 in age-adjusted mortality and numbers of deaths associated with heart diseases in data from the Centers for Disease Control and Prevention and other sources.

During that period, the 65-and-older population grew by about 23.0%, while the ranks of those younger than 65 went up by only 1.7%.

At the same time, the age-adjusted mortality rate for heart disease overall declined by 5% and for CHD in particular by about 15%. But age-adjusted mortality associated with HF during that time climbed about 21%, the report notes.

That increase in age-adjusted HF mortality combined with growth in the 65-and-older group "resulted in what could be described as a fairly explosive increase in the number of deaths, a 38% increase in the number of deaths from heart failure during that time period," Sidney said.

The number of people 65 years or older in the United States is expected to grow about 44% by 2030, he and his colleagues observe. The rate of HF, they also note, is projected to rise 37% overall between 2015 and 2030, and by 57% in the 65-and-older group.

"We are now in the midst of a 'silver tsunami' of heart disease and heart failure," senior author Jamal S. Rana, MD, PhD, chief of cardiology at Kaiser Permanente Oakland Medical Center, told | Medscape Cardiology.

"This will require innovation in clinical care for our patients and urgent policy initiatives at the healthcare systems level for surveillance and prevention to be better prepared for its impact."

Sidney discloses receiving grants from the National Heart, Lung, and Blood Institute. Disclosures for the other authors are in the report.

JAMA Cardiology. Published online October 30, 2019. Report

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