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Current Heart Failure Reports

, Volume 9, Issue 4, pp 369–374 | Cite as

Aging of the United States Population: Impact on Heart Failure

  • Rebecca Vigen
  • Thomas M. Maddox
  • Larry A. Allen
Epidemiology of Heart Failure (J Butler, Section Editor)

Abstract

The United States population, particularly among older age groups, continues to expand. Because the incidence of heart failure increases with age, largely due to the development of heart failure risk factors such as hypertension and coronary artery disease, the epidemic of heart failure is likely to grow further in the coming decades. This article will review the epidemiology of heart failure among older adults, the influence of an aging population on heart failure prevalence and phenotype, the complications in management for a larger and older heart failure population, and the potential implications of these changes for health care costs and delivery. Ultimately, these challenges demand research into optimal therapeutic strategies for older heart failure patients, including improved prevention and treatment of the major causes of heart failure, an increasing role forpalliative care, and innovations in patient-centered health care delivery.

Keywords

Heart failure Aging Epidemiology Treatment 

Notes

Acknowledgement

L.A. Allen is supported by a grant from the National Institutes of Health National Heart Lung and Blood Institute (Grant 1K23HL105896) and by a Scientist Development Grant from the American Heart Association. R. Vigen is supported by a Cardiovascular Outcomes Research Fellowship through a Department of Veterans Affairs Graduate Medical Education Enhancement Grant. T.M. Maddox is supported by a Health Services Research and Development Career Development Award from thr U.S. Department of Veterans Affairs.

Disclosure

R. Vigen, none; T. M. Maddox, none. L. A. Allen is a board member for the Boettcher Foundation and a consultant for Amgen and Johnson & Johnson.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    United States Census Bureau. Projections of the Population by Selected Age Groups and Sex for the United States: 2010 to 2050. 2008. Available at www.census.gov/population/www/projections/summarytables.html. Accessed July 2012.
  2. 2.
    Werner CA. The Older Population: 2010. The 2010 Census Briefs, November 2011.Google Scholar
  3. 3.
    National Institute on Aging NIH, U.S. Department of Health and Human Services, U.S. Department of State. Why Population Aging Matters: A Global Perspective. 2007:1–32.Google Scholar
  4. 4.
    Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–44.PubMedCrossRefGoogle Scholar
  5. 5.
    Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation. 2012;125:e2–e220.PubMedCrossRefGoogle Scholar
  6. 6.
    National Institutes of Health: NHLBI. Incidence and Prevalence: 2006 Chart Book on Cardiovascular and Lung Diseases.Google Scholar
  7. 7.
    National Institutes of Health: NHLBI. Morbidity and Mortality: 2012 Chart Book on Cardiovascular, Lung, and Blood Diseases.Google Scholar
  8. 8.
    Butler J, Kalogeropoulos AP, Georgiopoulou VV, et al. Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition Study. Heart. 2011;97(16):1304–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Lloyd-Jones DM, Larson MG, Leip EP, et al. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106(24):3068–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Kalogeropoulos A, Georgiopoulou V, Kritchevsky SB, et al. Epidemiology of incident heart failure in a contemporary elderly cohort: the health, aging, and body composition study. Arch Intern Med. 2009;169(7):708–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Yoon S, Ostchega Y, Louis T. Recent trends in the prevalence of high blood pressure and its treatment and control, 1999–2008. NCHS Data Brief. 2010;48:1–8.PubMedGoogle Scholar
  12. 12.
    Velagaleti RS, Pencina MJ, Murabito JM, et al. Long-Term Trends in the Incidence of Heart Failure After Myocardial Infarction. Circulation. 2008;118(20):2057–62.PubMedCrossRefGoogle Scholar
  13. 13.
    Mann D, Reynolds K, Smith D, Muntner P. Trends in Statin Use and Low-Density Lipoprotein Cholesterol Levels Among US Adults: Impact of the 2001 National Cholesterol Education Program Guidelines. Ann Pharmacother. 2008;42(9):1208–15.PubMedCrossRefGoogle Scholar
  14. 14.
    Committee on Reducing Tobacco Use: Strategies B, Consequences. Ending the Tobacco Problem: A Blueprint for the Nation: The National Academies Press; 2007.Google Scholar
  15. 15.
    Yeh RW, Sidney S, Chandra M, et al. Population Trends in the Incidence and Outcomes of Acute Myocardial Infarction. N Engl J Med. 2010;362(23):2155–65.PubMedCrossRefGoogle Scholar
  16. 16.
    Kannel WB. Incidence and epidemiology of heart failure. Hear Fail Rev. 2000;5(2):167–73.CrossRefGoogle Scholar
  17. 17.
    Murad K, Kitzman D. Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management. Hear Fail Rev. 2012;17(4):581–8.CrossRefGoogle Scholar
  18. 18.
    Kitzman DW, Gardin JM, Gottdiener JS, et al. Importance of heart failure with preserved systolic function in patients ≥65 years of age. Am J Cardiol. 2001;87(4):413–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Owan TE, Hodge DO, Herges RM, et al. Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2006;355(3):251–9.PubMedCrossRefGoogle Scholar
  20. 20.
    •• Steinberg BA, Zhao X, Heidenreich PA, et al. Trends in Patients Hospitalized with Heart Failure and Preserved Left Ventricular Ejection Fraction - Prevalence, Therapies, and Outcomes. Circulation. 2012. This study describes differences in demographics, comorbidities, prevalence, and outcomes among patients with heart failure and normal ejection fraction versus those with borderline and reduced ejection fraction who are hospitalized for heart failure.Google Scholar
  21. 21.
    Cherubini A, Oristrell J, Pla X, et al. The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Arch Intern Med. 2011;171(6):550–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Krum H, Hill J, Fruhwald F, et al. Tolerability of beta-blockers in elderly patients with chronic heart failure: the COLA II study. Eur J Hear Fail. 2006;8(3):302–7.CrossRefGoogle Scholar
  23. 23.
    Muzzarelli S, Maeder MT, Toggweiler S, et al. Frequency and Predictors of Hyperkalemia in Patients ≥60 Years of Age With Heart Failure Undergoing Intense Medical Therapy. Am J Cardiol. 2012;109(5):693–8.PubMedCrossRefGoogle Scholar
  24. 24.
    • Komajda M, Hanon O, Hochadel M, et al. Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II. Eur Hear J. 2009;30(4):478–86. This study compares the management and outcomes among octogenarians and younger adults hospitalized with heart failure across Europe. Management and outcomes are also compared across time, between 2000–2001 and 2004–2005.CrossRefGoogle Scholar
  25. 25.
    Santangeli P, Di Biase L, Dello Russo A, et al. Meta-analysis: age and effectiveness of prophylactic implantable cardioverter-defibrillators. Ann Intern Med. 2010;153(9):592–9.PubMedGoogle Scholar
  26. 26.
    • Alsheikh-Ali AA, Trikalinos TA, Ruthazer R, et al. Risk of arrhythmic and nonarrhythmic death in patients with heart failure and chronic kidney disease. Am Heart J. 2011;161(1):204–9.e1. This study shows that the proportion of patients who die from nonarrhythmic versus arrhythmic death increases among patients with advanced heart failure and chronic kidney disease.PubMedCrossRefGoogle Scholar
  27. 27.
    •• Ahluwalia SC, Gross CP, Chaudhry SI, et al. Change in comorbidity prevalence with advancing age among persons with heart failure. J Gen Int Med. 2011;26(10):1145–51. This retrospective cohort study of Medicare beneficiaries with heart failure describes the increasing incidence of comorbidities with age.CrossRefGoogle Scholar
  28. 28.
    van Kan GA, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med. 2010;26(2):275–86.CrossRefGoogle Scholar
  29. 29.
    Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Biol Sci Med Sci. 2001;56(3):M146–56.CrossRefGoogle Scholar
  30. 30.
    Newman AB, Gottdiener JS, McBurnie MA, et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol Ser A Biol Sci Med Sci. 2001;56(3):M158–66.CrossRefGoogle Scholar
  31. 31.
    Cacciatore F, Abete P, Mazzella F, et al. Frailty predicts long-term mortality in elderly subjects with chronic heart failure. Eur J Clin Invest. 2005;35(12):723–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Allen LA, Stevenson LW, Grady KL, et al. Decision making in advanced heart failure: a scientific statement from the American Heart Association. Circulation. 2012;125(15):1928–52.PubMedCrossRefGoogle Scholar
  33. 33.
    Dunlay SM, Shah ND, Shi Q, et al. Lifetime costs of medical care after heart failure diagnosis. Circ Cardiovasc Qual Outcomes. 2011;4(1):68–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Braunstein JB, Anderson GF, Gerstenblith G, et al. Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol. 2003;42(7):1226–33.PubMedCrossRefGoogle Scholar
  35. 35.
    Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003;362(9386):777–81.PubMedCrossRefGoogle Scholar
  36. 36.
    Flather MD, Shibata MC, Coats AJS, et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J. 2005;26(3):215–25.PubMedCrossRefGoogle Scholar
  37. 37.
    Cleland JGF, Tendera M, Adamus J, et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006;27(19):2338–45.PubMedCrossRefGoogle Scholar
  38. 38.
    Bhuiyan T, Maurer M. Heart failure with preserved ejection fraction: persistent diagnosis, therapeutic enigma. Curr Cardiovasc Risk Rep. 2011;5(5):440–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Goebel JR, Doering LV, Shugarman LR, Asch SM, Sherbourne CD, Lanto AB, et al. Heart failure: the hidden problem of pain. J Pain Symptom Manag. 2009;38(5):698–707.CrossRefGoogle Scholar
  40. 40.
    Bekelman DB, Havranek EP. Palliative care for patients with acute decompensated heart failure: an underused service? Nat Clin Pract Cardiovasc Med. 2008;5(5):250–1.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Rebecca Vigen
    • 1
    • 2
    • 3
  • Thomas M. Maddox
    • 1
    • 2
    • 3
  • Larry A. Allen
    • 1
    • 3
    • 4
  1. 1.Division of CardiologyUniversity of Colorado School of MedicineAuroraUSA
  2. 2.VA Eastern Colorado Health Care SystemDenverUSA
  3. 3.Colorado Cardiovascular Outcomes Research ConsortiumDenverUSA
  4. 4.University of Colorado Anschutz Medical CenterAuroraUSA

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