We are in the midst of a proclaimed epidemic of heart failure, as evidenced by increases in the number of hospitalizations for heart failure, the number of deaths attributed to heart failure, and the costs associated with care. In this issue of the Journal, we are provided with good news regarding the heart failure epidemic. Levy et al. report data from the Framingham Heart Study indicating that the survival of patients in the community who have a diagnosis of heart failure is (finally) improving and that the incidence of heart failure may be declining. As we consider the implications of these data, the complexity of the epidemic and our incomplete understanding of its genesis deserve comment.
Will the Epidemic of Heart Failure Continue ?
Projected population demographics clearly indicate a progressive increase in the segment of the U.S. population that is 65 years of age or older. Given the high incidence of heart failure in persons in this age category, only a dramatic decrease in incidence or a decrease in survival after heart failure, commensurate with the changes in population demographics, could prevent further increases in the number of persons with heart failure in this country. Survival after heart failure appears to be increasing, not decreasing, and the lack of convincing evidence that the incidence of heart failure has decreased since the 1970s in men or in women suggests that there is little hope for an imminent end to the heart failure epidemic. Indeed, these data underscore the complexity of the epidemic and our inability to understand with confidence whether let alone why the epidemiology of heart failure is changing.
By Levy, D.
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