Cardiology Experts Warn of Rising Heart Failure Rates and Worsening Disparities in New 2024 Report

The latest findings on heart failure (HF) published by Heart Failure Society of America (HFSA) reveal a concerning rise in the prevalence, mortality, and impact of this debilitating condition in the United States. According to the HF Stats 2024: Heart Failure Epidemiology and Outcomes Statistics, approximately 6.7 million Americans over the age of 20 currently live with heart failure, a figure projected to rise to 8.7 million by 2030, 10.3 million by 2040, and a staggering 11.4 million by 2050. The report was published today in the Journal of Cardiac Failure (JCF).

This year's findings underscore some of the most alarming trends seen in heart failure in recent years. While HF rates have steadily increased over the last decade, the 2024 report shows that the problem is growing even more severe, particularly in younger populations, racial and ethnic minority groups, and those with multiple health conditions.

While trends among patient populations are concerning, the report also identifies challenges with implementation and reporting. Despite established guidelines emphasizing the timely initiation of guideline directed medical therapies (GMDT), the data indicate that implementation is falling short, which may be fueling the increase in both mortality and hospitalization rates for HF, particularly among at-risk populations. Inconsistent coding practices that fail to recognize HF as a primary underlying cause of death may lead to under-detection and under-reporting of HF deaths, suggesting that the actual burden of HF may be higher than current data shows.

"The shifts in age distribution, worsening in mortality rates, widening racial and ethnic disparities –which may be a reflection of systematic and structural barriers to appropriate and timely health care – should be a wake-up call for clinicians, payers, legislators, funding agencies, and the overall healthcare system," said Biykem Bozkurt, MD, PhD, Baylor College of Medicine and chair of the HFSA Data in HF Committee. "We need to address worsening trends in heart failure, not only through medical interventions and properly implemented GDMT, but by tackling the growing challenges in health care regarding access and coverage for appropriate and timely care, the effect of mis-incentivization of wrong care such as inappropriate discontinuation of therapies, and social determinants of health that are driving widening disparities."

Concerning Findings in the HF Stats 2024: Heart Failure Epidemiology and Outcomes Statistics

The HF Stats 2024: Heart Failure Epidemiology and Outcomes Statistics highlights several key findings, revealing an evolving crisis that could impact millions of Americans over the coming decades:

• Greater Impact on Younger Patients: The proportion of younger patients (aged 35-64) with heart failure has increased, showing a higher annual rise in mortality compared to older adults. This trend suggests that heart failure is no longer just a disease of aging but one that is increasingly affecting younger populations.
• Mortality Surge in 2021: While the 2023 report noted an upward trend in HF-related deaths since 2012, the 2024 report reveals a significant acceleration in 2020-2021, when 425,147 deaths were linked to HF, accounting for 45% of cardiovascular deaths.
• Racial Disparities Worsening: As in previous years, Black, American Indian, and Alaska Native individuals continue to have the highest all-cause age-adjusted HF mortality rates. The mortality rate for Black individuals has risen faster than any other racial or ethnic group, particularly in those under 65. The overall prevalence of heart failure has also increased among Black and Hispanic populations.
• Impact of Comorbidities: Obesity and hypertension remain critical risk factors for heart failure, but the 2024 report emphasizes the rising threat of clusters of comorbidities—multiple health conditions that are compounding the risk of HF.
• COVID-19 Impact: For the first time, this year's report noted that HF hospitalization rates were temporarily reduced between 2020-2022 due to the pandemic. However, long-term trends still show a steady increase in hospitalizations across all age groups and racial categories, with Black patients disproportionately affected.

Along with the inaugural report, HFSA launched HFStats.org, an online repository of these HF statistics, complete with Fact Sheets, Infographics, and other downloadable materials. Updated and new statistics from HF Stats 2024: Heart Failure Epidemiology and Outcomes Statistics will be made available on HFStats.org in the coming months. At present time, the report is published in JCF and available online under Articles in Press at www.onlinejcf.com.

DOI: 10.1016/j.cardfail.2023.07.006

Summary of Top 10 Key Points

1. Approximately 6.7 million Americans over 20 years of age have heart failure (HF), and the prevalence is expected to rise to 8.7 million in 2030,10.3 million in 2040, and 11.4 million by 2050.
2. The lifetime risk of HF has increased to 24%; approximately 1 in 4 persons will develop HF in their lifetime.
3. The proportion of younger patients with HF is increasing compared to the proportion of older patients.
4. Approximately one-third of the adult population in the United States (US) is at risk for HF (Stage A), and 24-34% of the US population has pre-HF (Stage B). The risk of developing HF has increased in individuals with obesity, hypertension, and clusters of comorbidities.
5. The incidence and prevalence of HF is higher among Black individuals compared with other racial and ethnic groups. The prevalence of HF has increased among Black and Hispanic individuals over time.
6. HF mortality rates have been increasing since 2012 with a more pronounced acceleration in 2020-2021. The age-adjusted HF mortality rates were higher in 2021 than in 1999. HF was a contributing cause in approximately 425,147 deaths and accounted for 45% of cardiovascular deaths in the US in 2021.
7. Black, American Indian, and Alaskan Native individuals have the highest all-cause age-adjusted HF mortality rates compared with other racial and ethnic groups. From 2010 to 2020, HF mortality rates have increased for Black individuals at a rate higher than any other racial or ethnic group, particularly for individuals below the age of 65.
8. A greater relative annual increase in HF-related mortality rates has been noted for younger (35-64 years) compared with older (65-84 years) adults.
9. Highest HF death rates have been reported in the Midwest, Southeast, and Southern states. Rural areas demonstrate higher HF mortality rates for both younger and older age groups compared with urban areas.
10. Rates of HF hospitalizations have increased since 2014. This increase was consistent between age groups and sexes, with the highest rates being among Black patients. Between 2020-2022, HF hospitalization rates were temporarily reduced during COVID-19 pandemic.

About the Heart Failure Society of America

The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. The mission of HFSA is to provide a platform to improve and expand heart failure care through collaboration, education, innovation, research, and advocacy. HFSA members include physicians, scientists, nurses, nurse practitioners, pharmacists, trainees, other healthcare workers and patients. For more information, visit hfsa.org.

About the Journal of Cardiac Failure

The Journal of Cardiac Failure (JCF) publishes the highest quality science in the field of heart failure with a focus on diversity, equity, and inclusion, mentorship, multidisciplinary partnerships, and patient-centeredness. Published papers span original investigator-initiated work to state-of-the-art reviews, guidelines and scientific statements, expert perspectives, early career and trainee spotlight pieces, patient and patient-partner narratives. JCF also emphasizes the power of language and prioritizes innovative approaches to dissemination of published work to reach and impact the broader heart failure community.

SOURCE Heart Failure Society of America

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