Heart Failure Risk Distribution and Trends in the United States Population,NHANES 1999-2016

BackgroundImplementation of effective preventive interventions requires identification of high-risk individuals. We sought to define the distribution and trends of heart failure risk in the US population.MethodsWe calculated 10-year predicted heart failure risk among a representative sample of US adults aged 30-79 years, without baseline cardiovascular disease, from the National Health and Nutrition Examination Surveys (NHANES) 1999-2016. We used the published Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) model, which integrates demographic and risk factor data, to estimate 10-year heart failure risk. Participants were stratified by NHANES cycle, sex, age, and race/ethnicity and by 10-year heart failure risk, defined as low (<1%), intermediate (1% to <5%), and high (≥5%).ResultsFrom 1999-2000 to 2015-2016, mean predicted 10-year heart failure risk increased significantly from 2.0% to 3.0% (P < .05) in the population, most notably among non-Hispanic black (2.1% to 3.7%) and non-Hispanic white (2.4% to 3.6%) men. In 2013-2016, 17.6% of the studied population was at high predicted 10-year heart failure risk. The prevalence of high predicted heart failure risk was highest among non-Hispanic black men (23.1%), followed by non-Hispanic white men (19.2%) and non-Hispanic white women (17.9%).DiscussionMean population risk of heart failure increased significantly from 1999-2016. A substantial proportion of US adults are at high 10-year heart failure risk (≥5%), particularly non-Hispanic black men. These data underscore the importance of identifiying individuals at increased heart failure risk for targeted prevention measures to reduce the future burden of heart failure.     

Use of Outpatient Intravenous Calcitropes for Heart Failure in the United States

BackgroundOutpatient calcitrope infusions—that is, the cardiac inotropes milrinone and dobutamine—are often used for bridge to transplantation and palliation in advanced heart failure, but few data exist about the real-world use of these agents.Methods and ResultsWe used the Symphony Integrated DataVerse of commercial, managed Medicare, and Medicaid insurance claims of approximately 280 million people (2012–2020) to determine the incidence and characteristics of ambulatory calcitrope use. Demographics were calculated, including geographic densities at the metropolitan statistical area level. A population projection normalized for age, sex, and location was extrapolated to the total US population. Ambulatory dispensing of milrinone was found in 10,533 outpatients, 1867 in 2019. Ambulatory dobutamine use was found in 4967 outpatients, 836 in 2019. The 2019 total US projection was 3411 for milrinone and 1281 for dobutamine. The mean age was 62 years for milrinone and 68 for dobutamine. Males represented 70% of use. There were differences between drugs in geographic distribution, with more milrinone use in the Northeast and South and more dobutamine use in the Midwest. Duration of use was 4.6 ± 7.2 months for milrinone and 1.8 ± 4.0 months for dobutamine. Of the patients receiving milrinone, 30.6% subsequently underwent cardiac transplantation or left ventricular assist device placement, whereas 10% receiving dobutamine went on to advanced therapies. Less than 0.5% of patients received calcitropes while enrolled in hospice care.ConclusionsMore than 4000 patients receive outpatient infusion of calcitropes annually in the outpatient setting. Men are much more likely to receive these medications. A minority of the use is as a bridge to advanced therapies. Geographic variability in use suggests better evidence and consistent guidelines may be helpful.     

Nationwide Frequency and Association of Heart Failure on Stroke Outcomes in the United States

BackgroundFew studies of the effect of heart failure (HF) on stroke outcomes have been published. This study was designed to determine the association of co-existing HF with in-hospital length-of-stay (LOS), cost, and mortality among acute stroke patients admitted to hospitals in the United States (US).Methods and ResultsAll patients with a primary diagnosis of stroke admitted to the US hospitals in calendar years 1995 and 2005 were extracted using the National Inpatient Sample (NIS) database. Patients were categorized based on a secondary diagnosis of HF. Patients' demographics, LOS, in-hospital death, disposition, and hospitalization costs were determined. The odds ratio of in-hospital mortality rates for stroke patients with HF were 2.5 (95% CI: 2.4–2.7) and 2.2 (95% CI: 2.0–2.3) in 1995 and 2005, respectively, compared to those without HF. Stroke patients with HF also stayed longer in the hospital in both years studied, though a general decline in LOS was observed in 2005. The estimated increase in total hospitalization cost for stroke patients with HF was $1,100 (20% difference, 95% CI: 18%–23%) and $1,300 (18% difference, 95% CI: 16%–20%) for 1995 and 2005, respectively.ConclusionsThe results of our study suggest that there is an association between co-existing HF and mortality in stroke patients. Stroke patients with HF appear to have a higher mortality rate, longer LOS, and higher hospitalization cost compared to those without HF. The mechanism of higher stroke mortality and morbidity in patients with HF requires further investigation to identify modifiable factors and to tailor better treatment options.     

Early Heart Failure in the Population

ABSTRACT A cross-sectional analysis of characteristics possibly associated with congestive heart failure (CHF) was performed among 644 men, all 67 years of age and randomly selected from the general population. A total of 13% had symptoms and signs of overt CHF. Another 10% had early or “latent” CHF. Among overt CHF cases, 46% had hypertension, 55% coronary heart disease and 79% any one of these conditions. Among “latent” CHF cases, the corresponding proportions were 52%, 25 % and 65 %. Simple indices of left ventricular diastolic function and filling pressure as well as of pulmonary artery pressure were closer related to the CHF stage, than were measures of systolic left ventricular function. Smoking habits, hypertension, blood lipids, weight and other measures of body fat, blood glucose, and serum insulin were all correlated to CHF stage. In a multivariate analysis, smoking habits, hypertension, body weight, and serum insulin were independently and significantly correlated to CHF stage.     

Mortality From Heart Failure and Dementia in the United States: CDC WONDER 1999–2016

Background

Heart failure and dementia are diseases of the elderly that result in billions of dollars in annual health care expenditure. With the aging of the United States population and increasing evidence of shared risk factors, there is a need to understand the conditions’ shared contributions to nationwide mortality. The objectives of this study were to estimate the burden of mortality from heart failure and dementia and characterize the demographics of affected individuals.

Frailty Assessment in Heart Failure and Ventricular Assist Device Populations: A Review from the United States

ImportancePost-operative risk is increased with frail individuals undergoing cardiac surgery. Yet, there is no consensus for frailty assessment prior to durable left ventricular assist device (dLVAD) evaluation.ObjectiveThe objectives of this integrative review were to describe frailty measures, examine psychometrics of measures used, and identify variables related to frailty in heart failure with reduced ejection fraction (HFrEF) and dLVAD populations.Design, Setting, ParticipantsPubMed, CINAHL, and Embase databases were searched for terms related to frailty, HFrEF and dLVAD that met inclusion criteria.ResultsFourteen articles met inclusion criteria. Frailty was inconsistently defined. The Fried Phenotype Criteria was the most widely used approach to measurement. Validity was reported in all articles. Variables related to frailty included readmissions, higher mortality and increased adverse events.ConclusionThere was variability in frailty definition and frailty measurement across studies. Further research in HFrEF and dLVAD populations is needed for frailty evaluation.     

Nonadherence in the Advanced Heart Failure Population

The number of patients living with heart failure (HF) in the USA now exceeds 5 million. Although HF is a disease readily treated by medications and lifestyle interventions, nonadherence is common, leading to worse clinical outcomes and increased healthcare costs. While adherence to medical therapy and clinician recommendations is key in the management of HF, it is perhaps more critical in patients with the most advanced disease, including those receiving home inotropic infusion, heart transplantation, or a left ventricular assist device. Yet, there is a paucity of data on the effects of nonadherence on the advanced heart failure population and little information on the most effective management strategies in these patients. Future studies of nonadherence in HF should utilize uniform definitions of adherence and, ideally, more objective measurements of adherence such as the novel “digital pill” technology.