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  • Review Article
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Epidemiology and risk profile of heart failure

Abstract

Heart failure (HF) is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five. Although promising evidence shows that the age-adjusted incidence of HF may have plateaued, HF still carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. HF represents a considerable burden to the health-care system, responsible for costs of more than $39 billion annually in the USA alone, and high rates of hospitalizations, readmissions, and outpatient visits. HF is not a single entity, but a clinical syndrome that may have different characteristics depending on age, sex, race or ethnicity, left ventricular ejection fraction (LVEF) status, and HF etiology. Furthermore, pathophysiological differences are observed among patients diagnosed with HF and reduced LVEF compared with HF and preserved LVEF, which are beginning to be better appreciated in epidemiological studies. A number of risk factors, such as ischemic heart disease, hypertension, smoking, obesity, and diabetes, among others, have been identified that both predict the incidence of HF as well as its severity. In this Review, we discuss key features of the epidemiology and risk profile of HF.

Key Points

  • Heart failure (HF) is a major public health issue that affects nearly 5.8 million individuals in the USA and 23 million worldwide

  • The prevalence of HF is increasing owing to the aging population and improved management of heart disease, but the age-adjusted incidence of HF seems to have plateaued

  • HF and preserved left ventricular ejection fraction (LVEF) has an increasingly prominent role in HF, representing more than half of HF cases, with outcomes similar to HF and reduced LVEF

  • Although mortality from HF has improved over the past few decades, it still results in a high 5-year mortality that rivals that of many cancers

  • Risk factors, such as ischemic heart disease, hypertension, smoking, obesity, and diabetes increase the risk of incident HF and predict poor outcomes in the setting of the disease

  • HF is a major source of health services utilization, being a leading cause of hospitalizations, readmissions, and outpatient visits at a cost of over $39 billion annually in the USA

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Figure 1: Prevalence of heart failure by age and sex in the USA.
Figure 2: Age-adjusted survival after the onset of heart failure in a | men and b | women over time, from 1950 to 1999, based on the Framingham Heart Study.
Figure 3: Survival after incident heart failure hospitalization by race and sex, based on the ARIC (Atherosclerosis Risk in Communities) Study, 1987–2002.
Figure 4: Time trends of age-adjusted hospitalization rates in men and women, based on the National Hospital Discharge Survey, 1979–2004.

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References

  1. Lloyd-Jones, D. et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 121, e46–e215 (2010).

    PubMed  Google Scholar 

  2. McMurray, J. J., Petrie, M. C., Murdoch, D. R. & Davie, A. P. Clinical epidemiology of heart failure: public and private health burden. Eur. Heart J. 19 (Suppl. P), P9–P16 (1998).

    PubMed  Google Scholar 

  3. Levy, D. et al. Long-term trends in the incidence of and survival with heart failure. N. Engl. J. Med. 347, 1397–1402 (2002).

    Article  PubMed  Google Scholar 

  4. Schocken, D. D., Arrieta, M. I., Leaverton, P. E. & Ross, E. A. Prevalence and mortality rate of congestive heart failure in the United States. J. Am. Coll. Cardiol. 20, 301–306 (1992).

    Article  CAS  PubMed  Google Scholar 

  5. Fang, J., Mensah, G. A., Croft, J. B. & Keenan, N. L. Heart failure-related hospitalization in the U.S., 1979 to 2004. J. Am. Coll. Cardiol. 52, 428–434 (2008).

    Article  PubMed  Google Scholar 

  6. Hoes, A. W., Mosterd, A. & Grobbee, D. E. An epidemic of heart failure? Recent evidence from Europe. Eur. Heart J. 19 (Suppl. L), L2–L9 (1998).

    PubMed  Google Scholar 

  7. McCullough, P. A. et al. Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J. Am. Coll. Cardiol. 39, 60–69 (2002).

    Article  PubMed  Google Scholar 

  8. Croft, J. B. et al. Heart failure survival among older adults in the United States: a poor prognosis for an emerging epidemic in the Medicare population. Arch. Intern. Med. 159, 505–510 (1999).

    Article  CAS  PubMed  Google Scholar 

  9. Rich, M. W. Heart failure in the 21st century: a cardiogeriatric syndrome. J. Gerontol. A Biol. Sci. Med. Sci. 56, M88–M96 (2001).

    Article  CAS  PubMed  Google Scholar 

  10. Barker, W. H., Mullooly, J. P. & Getchell, W. Changing incidence and survival for heart failure in a well-defined older population, 1970–1974 and 1990–1994. Circulation 113, 799–805 (2006).

    Article  PubMed  Google Scholar 

  11. Loehr, L. R., Rosamond, W. D., Chang, P. P., Folsom, A. R. & Chambless, L. E. Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study). Am. J. Cardiol. 101, 1016–1022 (2008).

    Article  PubMed  Google Scholar 

  12. Roger, V. L. et al. Trends in heart failure incidence and survival in a community-based population. JAMA 292, 344–350 (2004).

    Article  CAS  PubMed  Google Scholar 

  13. Senni, M. et al. Congestive heart failure in the community: trends in incidence and survival in a 10-year period. Arch. Intern. Med. 159, 29–34 (1999).

    Article  CAS  PubMed  Google Scholar 

  14. [No authors listed] Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Group. N. Engl. J. Med. 316, 1429–1435 (1987).

  15. Jhund, P. S. et al. Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5.1 million people. Circulation 119, 515–523 (2009).

    Article  PubMed  Google Scholar 

  16. Tu, J. V. et al. National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke, 1994–2004. CMAJ 180, E118–E125 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  17. Redfield, M. M. Heart failure—an epidemic of uncertain proportions. N. Engl. J. Med. 347, 1442–1444 (2002).

    Article  PubMed  Google Scholar 

  18. Lee, D. S. et al. Trends in heart failure outcomes and pharmacotherapy: 1992 to 2000. Am. J. Med. 116, 581–589 (2004).

    Article  CAS  PubMed  Google Scholar 

  19. Bhatia, R. S. et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N. Engl. J. Med. 355, 260–269 (2006).

    Article  CAS  PubMed  Google Scholar 

  20. Massie, B. M. et al. Irbesartan in patients with heart failure and preserved ejection fraction. N. Engl. J. Med. 359, 2456–2467 (2008).

    Article  CAS  PubMed  Google Scholar 

  21. Owan, T. E. et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N. Engl. J. Med. 355, 251–259 (2006).

    Article  CAS  PubMed  Google Scholar 

  22. Davis, R. C., Hobbs, F. D. & Lip, G. Y. ABC of heart failure. History and epidemiology. BMJ 320, 39–42 (2000).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Remes, J., Miettinen, H., Reunanen, A. & Pyörälä, K. Validity of clinical diagnosis of heart failure in primary health care. Eur. Heart J. 12, 315–321 (1991).

    Article  CAS  PubMed  Google Scholar 

  24. McKee, P. A. et al. The natural history of congestive heart failure: the Framingham study. N. Engl. J. Med. 285, 1441–1446 (1971).

    Article  CAS  PubMed  Google Scholar 

  25. Di Bari, M. et al. The diagnosis of heart failure in the community. Comparative validation of four sets of criteria in unselected older adults: the ICARe Dicomano Study. J. Am. Coll. Cardiol. 44, 1601–1608 (2004).

    Article  PubMed  Google Scholar 

  26. Schellenbaum, G. D. et al. Survival associated with two sets of diagnostic criteria for congestive heart failure. Am. J. Epidemiol. 160, 628–635 (2004).

    Article  PubMed  Google Scholar 

  27. Schellenbaum, G. D. et al. Congestive heart failure incidence and prognosis: case identification using central adjudication versus hospital discharge diagnoses. Ann. Epidemiol. 16, 115–122 (2006).

    Article  PubMed  Google Scholar 

  28. Goff, D. C., Jr, Pandey, D. K., Chan, F. A., Ortiz, C. & Nichaman, M. Z. Congestive heart failure in the United States: is there more than meets the I(CD code)? The Corpus Christi Heart Project. Arch. Intern. Med. 160, 197–202 (2000).

    Article  PubMed  Google Scholar 

  29. Higgins, M. W. The Framingham Heart Study: review of epidemiological design and data, limitations and prospects. Prog. Clin. Biol. Res. 147, 51–64 (1984).

    CAS  PubMed  Google Scholar 

  30. Gordis, L. Epidemiology 37–84 (Elsevier/Saunders, Philadelphia, 2009).

    Google Scholar 

  31. Redfield, M. M. et al. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289, 194–202 (2003).

    Article  PubMed  Google Scholar 

  32. Mosterd, A. et al. Prevalence of heart failure and left ventricular dysfunction in the general population; The Rotterdam Study. Eur. Heart J. 20, 447–455 (1999).

    Article  CAS  PubMed  Google Scholar 

  33. Kannel, W. B., Ho, K. & Thom, T. Changing epidemiological features of cardiac failure. Br. Heart J. 72, S3–S9 (1994).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Curtis, L. H. et al. Incidence and prevalence of heart failure in elderly persons, 1994–2003. Arch. Intern. Med. 168, 418–424 (2008).

    Article  PubMed  Google Scholar 

  35. Mosterd, A. & Hoes, A. W. Clinical epidemiology of heart failure. Heart 93, 1137–1146 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Mendez, G. F. & Cowie, M. R. The epidemiological features of heart failure in developing countries: a review of the literature. Int. J. Cardiol. 80, 213–219 (2001).

    Article  CAS  PubMed  Google Scholar 

  37. Yach, D., Hawkes, C., Gould, C. L. & Hofman, K. J. The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA 291, 2616–2622 (2004).

    Article  CAS  PubMed  Google Scholar 

  38. Yusuf, S., Reddy, S., Ounpuu, S. & Anand, S. Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation 104, 2855–2864 (2001).

    Article  CAS  PubMed  Google Scholar 

  39. Lloyd-Jones, D. M. et al. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation 106, 3068–3072 (2002).

    Article  PubMed  Google Scholar 

  40. Gottdiener, J. S. et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J. Am. Coll. Cardiol. 35, 1628–1637 (2000).

    Article  CAS  PubMed  Google Scholar 

  41. Djoussé, L., Kochar, J. & Gaziano, J. M. Secular trends of heart failure among US male physicians. Am. Heart J. 154, 855–860 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Yusuf, S., Thom, T. & Abbott, R. D. Changes in hypertension treatment and in congestive heart failure mortality in the United States. Hypertension 13, I74–I79 (1989).

    Article  CAS  PubMed  Google Scholar 

  43. Burt, V. L. et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension 26, 60–69 (1995).

    Article  CAS  PubMed  Google Scholar 

  44. Bonneux, L., Barendregt, J. J., Meeter, K., Bonsel, G. J. & van der Maas, P. J. Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure. Am. J. Public Health 84, 20–28 (1994).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Hunt, S. A. et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 112, e154–e235 (2005).

    Article  PubMed  Google Scholar 

  46. Yancy, C. W. Heart failure in African Americans. Am. J. Cardiol. 96, 3i–12i (2005).

    Article  PubMed  Google Scholar 

  47. Bibbins-Domingo, K. et al. Racial differences in incident heart failure among young adults. N. Engl. J. Med. 360, 1179–1190 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Goldberg, R. J., Ciampa, J., Lessard, D., Meyer, T. E. & Spencer, F. A. Long-term survival after heart failure: a contemporary population-based perspective. Arch. Intern. Med. 167, 490–496 (2007).

    Article  PubMed  Google Scholar 

  49. Bleumink, G. S. et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure. The Rotterdam Study. Eur. Heart J. 25, 1614–1619 (2004).

    Article  PubMed  Google Scholar 

  50. Stewart, S., MacIntyre, K., Hole, D. J., Capewell, S. & McMurray, J. J. More 'malignant' than cancer? Five-year survival following a first admission for heart failure. Eur. J. Heart Fail. 3, 315–322 (2001).

    Article  CAS  PubMed  Google Scholar 

  51. Ni, H., Nauman, D. J. & Hershberger, R. E. Analysis of trends in hospitalizations for heart failure. J. Card. Fail. 5, 79–84 (1999).

    Article  CAS  PubMed  Google Scholar 

  52. Polanczyk, C. A., Rohde, L. E., Dec, G. W. & DiSalvo, T. Ten-year trends in hospital care for congestive heart failure: improved outcomes and increased use of resources. Arch. Intern. Med. 160, 325–332 (2000).

    Article  CAS  PubMed  Google Scholar 

  53. Fonarow, G. C., Adams, K. F., Jr, Abraham, W. T., Yancy, C. W. & Boscardin, W. J. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA 293, 572–580 (2005).

    Article  CAS  PubMed  Google Scholar 

  54. Bueno, H. et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. JAMA 303, 2141–2147 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. [No authors listed] Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. N. Engl. J. Med. 325, 293–302 (1991).

  56. Ahn, S. A. et al. Early versus delayed enalapril in patients with left ventricular systolic dysfunction: impact on morbidity and mortality 15 years after the SOLVD trial. J. Am. Coll. Cardiol. 47, 1904–1905 (2006).

    Article  CAS  PubMed  Google Scholar 

  57. Lindenfeld, J. et al. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J. Card. Fail. 16, e1–e194 (2010).

    Article  PubMed  Google Scholar 

  58. Aurigemma, G. P., Zile, M. R. & Gaasch, W. H. Contractile behavior of the left ventricle in diastolic heart failure: with emphasis on regional systolic function. Circulation 113, 296–304 (2006).

    Article  PubMed  Google Scholar 

  59. Lam, C. S., Donal, E., Kraigher-Krainer, E. & Vasan, R. S. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur. J. Heart Fail. doi:10.1093/eurjhf/hfq121.

    Article  PubMed  Google Scholar 

  60. Aurigemma, G. P. & Gaasch, W. H. Clinical practice. Diastolic heart failure. N. Engl. J. Med. 351, 1097–1105 (2004).

    Article  CAS  PubMed  Google Scholar 

  61. Paulus, W. J. et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur. Heart J. 28, 2539–2550 (2007).

    Article  PubMed  Google Scholar 

  62. Zile, M. R. et al. Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation 104, 779–782 (2001).

    Article  CAS  PubMed  Google Scholar 

  63. Vasan, R. S., Benjamin, E. J. & Levy, D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J. Am. Coll. Cardiol. 26, 1565–1574 (1995).

    Article  CAS  PubMed  Google Scholar 

  64. Owan, T. E. & Redfield, M. M. Epidemiology of diastolic heart failure. Prog. Cardiovasc. Dis. 47, 320–332 (2005).

    Article  PubMed  Google Scholar 

  65. Lee, D. S. et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the Framingham Heart Study of the National Heart, Lung, and Blood Institute. Circulation 119, 3070–3077 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  66. Bursi, F. et al. Systolic and diastolic heart failure in the community. JAMA 296, 2209–2216 (2006).

    Article  CAS  PubMed  Google Scholar 

  67. Fonarow, G. C. et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J. Am. Coll. Cardiol. 50, 768–777 (2007).

    Article  PubMed  Google Scholar 

  68. Lenzen, M. J. et al. Differences between patients with a preserved and a depressed left ventricular function: a report from the EuroHeart Failure Survey. Eur. Heart J. 25, 1214–1220 (2004).

    Article  CAS  PubMed  Google Scholar 

  69. Henkel, D. M., Redfield, M. M., Weston, S. A., Gerber, Y. & Roger, V. L. Death in heart failure: a community perspective. Circ. Heart Fail. 1, 91–97 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  70. Gottdiener, J. S. et al. Outcome of congestive heart failure in elderly persons: influence of left ventricular systolic function. The Cardiovascular Health Study. Ann. Intern. Med. 137, 631–639 (2002).

    Article  PubMed  Google Scholar 

  71. Setaro, J. F., Soufer, R., Remetz, M. S., Perlmutter, R. A. & Zaret, B. L. Long-term outcome in patients with congestive heart failure and intact systolic left ventricular performance. Am. J. Cardiol. 69, 1212–1216 (1992).

    Article  CAS  PubMed  Google Scholar 

  72. Davis, B. R. et al. Heart failure with preserved and reduced left ventricular ejection fraction in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Circulation 118, 2259–2267 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Pfeffer, M. A. et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 362, 759–766 (2003).

    Article  CAS  PubMed  Google Scholar 

  74. Somaratne, J. B. et al. The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis. Eur. J. Heart Fail. 11, 855–862 (2009).

    Article  PubMed  Google Scholar 

  75. Vasan, R. S. et al. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J. Am. Coll. Cardiol. 33, 1948–1955 (1999).

    Article  CAS  PubMed  Google Scholar 

  76. Yancy, C. W., Lopatin, M., Stevenson, L. W., De Marco, T. & Fonarow, G. C. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J. Am. Coll. Cardiol. 47, 76–84 (2006).

    Article  PubMed  Google Scholar 

  77. Solomon, S. D. et al. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation 116, 1482–1487 (2007).

    Article  PubMed  Google Scholar 

  78. Hogg, K., Swedberg, K. & McMurray, J. Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J. Am. Coll. Cardiol. 43, 317–327 (2004).

    Article  PubMed  Google Scholar 

  79. Kenchaiah, S., Narula, J. & Vasan, R. S. Risk factors for heart failure. Med. Clin. North Am. 88, 1145–1172 (2004).

    Article  PubMed  Google Scholar 

  80. He, J. et al. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch. Intern. Med. 161, 996–1002 (2001).

    Article  CAS  PubMed  Google Scholar 

  81. Chen, Y. T. et al. Risk factors for heart failure in the elderly: a prospective community-based study. Am. J. Med. 106, 605–612 (1999).

    Article  CAS  PubMed  Google Scholar 

  82. Hellermann, J. P. et al. Incidence of heart failure after myocardial infarction: is it changing over time? Am. J. Epidemiol. 157, 1101–1107 (2003).

    Article  PubMed  Google Scholar 

  83. Fonarow, G. C. et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch. Intern. Med. 168, 847–854 (2008).

    Article  PubMed  Google Scholar 

  84. Velagaleti, R. S. et al. Long-term trends in the incidence of heart failure after myocardial infarction. Circulation 118, 2057–2062 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  85. Goldberg, R. J. et al. A 25-year perspective into the changing landscape of patients hospitalized with acute myocardial infarction (the Worcester Heart Attack Study). Am. J. Cardiol. 94, 1373–1378 (2004).

    Article  PubMed  Google Scholar 

  86. Spencer, F. A. et al. Twenty year trends (1975–1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction: a community-wide perspective. J. Am. Coll. Cardiol. 34, 1378–1387 (1999).

    Article  CAS  PubMed  Google Scholar 

  87. Guidry, U. C. et al. Temporal trends in event rates after Q-wave myocardial infarction: the Framingham Heart Study. Circulation 100, 2054–2059 (1999).

    Article  CAS  PubMed  Google Scholar 

  88. Ezekowitz, J. A. et al. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction. J. Am. Coll. Cardiol. 53, 13–20 (2009).

    Article  PubMed  Google Scholar 

  89. Levy, D., Larson, M. G., Vasan, R. S., Kannel, W. B. & Ho, K. K. The progression from hypertension to congestive heart failure. JAMA 275, 1557–1562 (1996).

    Article  CAS  PubMed  Google Scholar 

  90. Psaty, B. M. et al. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. JAMA 277, 739–745 (1997).

    Article  CAS  PubMed  Google Scholar 

  91. Chapman, N. & Neal, B. Prospectively designed overviews of recent trials comparing antihypertensive regimens based on different drug classes. Curr. Hypertens. Rep. 3, 340–349 (2001).

    Article  CAS  PubMed  Google Scholar 

  92. Ingelsson, E., Sundström, J., Arnlöv, J., Zethelius, B. & Lind, L. Insulin resistance and risk of congestive heart failure. JAMA 294, 334–341 (2005).

    Article  CAS  PubMed  Google Scholar 

  93. Kannel, W. B. Incidence and epidemiology of heart failure. Heart Fail. Rev. 5, 167–173 (2000).

    Article  CAS  PubMed  Google Scholar 

  94. Bibbins-Domingo, K. et al. Predictors of heart failure among women with coronary disease. Circulation 110, 1424–1430 (2004).

    Article  PubMed  Google Scholar 

  95. From, A. M. et al. Diabetes in heart failure: prevalence and impact on outcome in the population. Am. J. Med. 119, 591–599 (2006).

    Article  PubMed  Google Scholar 

  96. Kronmal, R. A., Cain, K. C., Ye, Z. & Omenn, G. S. Total serum cholesterol levels and mortality risk as a function of age. A report based on the Framingham data. Arch. Intern. Med. 153, 1065–1073 (1993).

    Article  CAS  PubMed  Google Scholar 

  97. Kjekshus, J., Pedersen, T. R., Olsson, A. G., Faergeman, O. & Pyörälä, K. The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease. J. Card. Fail. 3, 249–254 (1997).

    Article  CAS  PubMed  Google Scholar 

  98. Hoffman, R. M., Psaty, B. M. & Kronmal, R. A. Modifiable risk factors for incident heart failure in the coronary artery surgery study. Arch. Intern. Med. 154, 417–423 (1994).

    Article  CAS  PubMed  Google Scholar 

  99. Suskin, N., Sheth, T., Negassa, A. & Yusuf, S. Relationship of current and past smoking to mortality and morbidity in patients with left ventricular dysfunction. J. Am. Coll. Cardiol. 37, 1677–1682 (2001).

    Article  CAS  PubMed  Google Scholar 

  100. Judge, K. W., Pawitan, Y., Caldwell, J., Gersh, B. J. & Kennedy, J. W. Congestive heart failure symptoms in patients with preserved left ventricular systolic function: analysis of the CASS registry. J. Am. Coll. Cardiol. 18, 377–382 (1991).

    Article  CAS  PubMed  Google Scholar 

  101. Kitzman, D. W. et al. Importance of heart failure with preserved systolic function in patients ≥65 years of age. CHS Research Group. Cardiovascular Health Study. Am. J. Cardiol. 87, 413–419 (2001).

    Article  CAS  PubMed  Google Scholar 

  102. Kenchaiah, S. et al. Obesity and the risk of heart failure. N. Engl. J. Med. 347, 305–313 (2002).

    Article  PubMed  Google Scholar 

  103. Goldberg, R. J., Spencer, F. A., Farmer, C., Meyer, T. E. & Pezzella, S. Incidence and hospital death rates associated with heart failure: a community-wide perspective. Am. J. Med. 118, 728–734 (2005).

    Article  PubMed  Google Scholar 

  104. Curtis, J. P. et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch. Intern. Med. 165, 55–61 (2005).

    Article  PubMed  Google Scholar 

  105. Kalantar-Zadeh, K., Block, G., Horwich, T. & Fonarow, G. C. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J. Am. Coll. Cardiol. 43, 1439–1444 (2004).

    Article  PubMed  Google Scholar 

  106. Djoussé, L., Kurth, T. & Gaziano, J. M. Cystatin C and risk of heart failure in the Physicians' Health Study (PHS). Am. Heart J. 155, 82–86 (2008).

    Article  PubMed  CAS  Google Scholar 

  107. Bibbins-Domingo, K. et al. Renal insufficiency as an independent predictor of mortality among women with heart failure. J. Am. Coll. Cardiol. 44, 1593–1600 (2004).

    Article  PubMed  Google Scholar 

  108. Schocken, D. D. et al. Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation 117, 2544–2565 (2008).

    Article  PubMed  Google Scholar 

  109. Cleland, J. G. et al. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet 360, 1631–1639 (2002).

    Article  CAS  PubMed  Google Scholar 

  110. Masoudi, F. A. & Krumholz, H. M. Polypharmacy and comorbidity in heart failure. BMJ 327, 513–514 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  111. Havranek, E. P. et al. Spectrum of heart failure in older patients: results from the National Heart Failure project. Am. Heart J. 143, 412–417 (2002).

    Article  PubMed  Google Scholar 

  112. Braunstein, J. B. et al. Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J. Am. Coll. Cardiol. 42, 1226–1233 (2003).

    Article  PubMed  Google Scholar 

  113. DeFrances, C. J., Lucas, C. A., Buie, V. C. & Golosinskiy, A. 2006 National Hospital Discharge Survey. Natl Health Stat. Report 5, 1–20 (2008).

    Google Scholar 

  114. Stewart, S. et al. Trends in hospitalization for heart failure in Scotland, 1990–1996. An epidemic that has reached its peak? Eur. Heart J. 22, 209–217 (2001).

    Article  CAS  PubMed  Google Scholar 

  115. McMurray, J., McDonagh, T., Morrison, C. E. & Dargie, H. J. Trends in hospitalization for heart failure in Scotland 1980–1990. Eur. Heart J. 14, 1158–1162 (1993).

    Article  CAS  PubMed  Google Scholar 

  116. Page, J. & Henry, D. Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an underrecognized public health problem. Arch. Intern. Med. 160, 777–784 (2000).

    Article  CAS  PubMed  Google Scholar 

  117. Jencks, S. F., Williams, M. V. & Coleman, E. A. Rehospitalizations among patients in the Medicare fee-for-service program. N. Engl. J. Med. 360, 1418–1428 (2009).

    Article  CAS  PubMed  Google Scholar 

  118. Feldman, D. E. et al. Changing trends in mortality and admissions to hospital for elderly patients with congestive heart failure in Montreal. CMAJ 165, 1033–1036 (2001).

    CAS  PubMed  PubMed Central  Google Scholar 

  119. Fonarow, G. C., Yancy, C. W. & Heywood, J. T. Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry. Arch. Intern. Med. 165, 1469–1477 (2005).

    Article  PubMed  Google Scholar 

  120. O'Connell, J. B. & Bristow, M. R. Economic impact of heart failure in the United States: time for a different approach. J. Heart Lung Transplant. 13, S107–S112 (1994).

    CAS  PubMed  Google Scholar 

  121. Chan, P. S. et al. Patient health status and costs in heart failure: insights from the eplerenone post-acute myocardial infarction heart failure efficacy and survival study (EPHESUS). Circulation 119, 398–407 (2009).

    Article  PubMed  Google Scholar 

  122. Hernandez, A. F. et al. Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA 303, 1716–1722 (2010).

    Article  CAS  PubMed  Google Scholar 

  123. Muus, K. J. et al. Effect of post-discharge follow-up care on re-admissions among US veterans with congestive heart failure: a rural-urban comparison. Rural Remote Health 10, 1447 (2010).

    PubMed  Google Scholar 

  124. Liao, L., Allen, L. A. & Whellan, D. J. Economic burden of heart failure in the elderly. Pharmacoeconomics 26, 447–462 (2008).

    Article  PubMed  Google Scholar 

  125. Stewart, S. et al. The current cost of heart failure to the National Health Service in the UK. Eur. J. Heart Fail. 4, 361–371 (2002).

    Article  PubMed  Google Scholar 

  126. Liao, L. et al. Costs for heart failure with normal vs reduced ejection fraction. Arch. Intern. Med. 166, 112–118 (2006).

    Article  PubMed  Google Scholar 

  127. Lee, W. C., Chavez, Y. E., Baker, T. & Luce, B. R. Economic burden of heart failure: a summary of recent literature. Heart Lung 33, 362–371 (2004).

    Article  PubMed  Google Scholar 

  128. Stewart, S., MacIntyre, K., Capewell, S. & McMurray, J. J. Heart failure and the aging population: an increasing burden in the 21st century? Heart 89, 49–53 (2003).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  129. Phillips, C. O. et al. Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis. JAMA 291, 1358–1367 (2004).

    Article  CAS  PubMed  Google Scholar 

  130. Inglis, S. C. et al. Extending the horizon in chronic heart failure: effects of multidisciplinary, home-based intervention relative to usual care. Circulation 114, 2466–2473 (2006).

    Article  PubMed  Google Scholar 

  131. Michalsen, A., König, G. & Thimme, W. Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 80, 437–441 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

A. L. Bui is supported by the NIH Kirschstein-NRSA fellowship. T. B. Horwich is a recipient of NIH/NHLBI 1K23HL085097. G. C. Fonarow holds the Eliot Corday Chair in Cardiovascular Medicine and Science and is also supported by the Ahmanson Foundation.

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All the authors contributed to discussion of content for the article, researched data to include in the manuscript, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments.

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Correspondence to Gregg C. Fonarow.

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G. C. Fonarow has worked as a consultant for Novartis, and received speaker's bureau honoraria from GlaxoSmithKline, Merck, Bristol-Myers Squibb/Sanofi, Pfizer, and Medtronic. A. L. Bui and T. B. Horwich declare no competing interests.

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Bui, A., Horwich, T. & Fonarow, G. Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8, 30–41 (2011). https://doi.org/10.1038/nrcardio.2010.165

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