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Epidemiology and risk profile of heart failure


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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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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Competing interests

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).

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