Elderly/Long-term Care

Fewer elderly persons are developing heart failure and those who do are surviving longer

Over the past decade, fewer elderly persons developed heart failure, and more of them are surviving longer with the disease, finds a new study of Medicare beneficiaries. The incidence of heart failure declined from 32 per 1,000 person-years in 1994 to 29 per 1,000 person-years in 2003. Incidence dropped most sharply among those aged 80 to 84 years (from 57.5 to 48.4 per 1,000 person-years) and rose only slightly among those aged 65 to 69 years (from 17.5 to 19.3 per 1,000 person-years).

Men continued to be more affected by heart failure than women. By 2003, nearly 130 per 1,000 men were diagnosed with the condition compared with 115 per 1,000 women. Heart failure mortality rates also declined during the study period.

Risk-adjusted 30-day, 1-year, and 5-year mortality rates decreased by more than 5 percent (from 13 to 12.6 percent for men and from 11.5 to 10.8 percent for women), 5 percent (from 28.9 to 27.5 percent), and 3 percent (from 67.5 to 64.9 percent for men and from 61.7 to 60.2 percent for women), respectively. Nevertheless, the prognosis for those with heart failure remained poor. For example, the 1-year mortality rate of 27.5 percent in 2002 was more than three times higher than for age- and sex-matched patients, and nearly two-thirds of those struck by the illness died within 5 years. Also, the average survival was 2.9 years following diagnosis, with women living slightly longer than men (3.1 vs. 2.7 years).

Identifying optimal strategies for the treatment and management of heart failure will become increasingly important as the size of the Medicare population grows, note the researchers. Their findings were based on a nationally representative sample of nearly 3 million Medicare beneficiaries age 65 or older, who were diagnosed with heart failure between 1994 and 2003. The study was supported in part by the Agency for Healthcare Research and Quality (HS10548).

See "Incidence and prevalence of heart failure in elderly persons, 1994-2003," by Lesley H. Curtis, Ph.D., David J. Whellan, M.D., M.H.S., Bradley G. Hammill, M.S., and others, in the February 25, 2008, Archives of Internal Medicine 168(4), pp. 418-424.

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