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CDC: After years of decline, US HF-related mortality rising again
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The U.S. age-adjusted HF-related death rate fell from 2000 to 2012 but rose from 2012 to 2014, according to a report from the CDC’s National Center for Health Statistics.
The rate of deaths for which HF was the underlying or a contributing cause was higher in non-Hispanic blacks than in other races, and over time the underlying cause of HF-related death was less likely to be CHD, Hanyu Ni, PhD, and Jiaquan Xu, MD, both from the division of vital statistics of the CDC’s National Center for Health Statistics, wrote in the report.
According to the report, the age-adjusted rate for HF-related deaths fell from 105.4 per 100,000 people in 2000 to 81.4 per 100,000 people in 2012 (P < .05), but rose to 84 per 100,000 people in 2014 (P < .05). The crude rate of HF-related deaths fell from 103.1 per 100,000 people in 2000 to 89.5 per 100,000 people in 2009 (P < .05), then rose to 96.9 per 100,000 in 2014 (P < .05).
Breakdown by race
The age-adjusted rate for HF-related death was higher in non-Hispanic blacks than in non-Hispanic whites and Hispanics from 2000 to 2014, with the 2014 rates being 91.5 per 100,000 people for non-Hispanic blacks, 87.3 per 100,000 people for non-Hispanic whites and 53.3 per 100,000 people for Hispanics (P < .05), according to the report.
The age-adjusted HF-related death rate fell 20% for non-Hispanic blacks and 22% for non-Hispanic whites between 2000 and 2012, but rose 4% for both between 2012 and 2014 (P < .05 for all), whereas it fell 27% for Hispanics from 2000 to 2014, Ni and Xu wrote.
In all age groups — 45 to 64 years, 65 to 74 years, 75 to 84 years and 85 years or older — the rate of HF-related death declined from 2000 to 2012 but rose from 2012 to 2014 (P < .05), with the death rate increasing with age (P < .05), according to the report.
The HF-related death rate was higher for men than for women in all age groups (P < .05), and the gap between men and women increased over time, the authors wrote.
Between 2000 and 2014, the percentage of HF-related deaths occurring at a hospital declined 30%, whereas the percentage at a descendant’s home increased 51%, the percentage at a nursing home or long-term care facility declined 11% and the percentage occurring elsewhere, such as an outpatient clinic or hospice facility, increased 74%, the report stated.
Less related to CHD
CHD was the underlying cause of HF-related death 34.9% of the time in 2000 but only 23.9% of the time in 2014 (P < .05), an overall decrease of 32%, the authors wrote. The percentage of other CVD being the underlying cause rose from 35.6% in 2000 to 41.2% in 2014 and the percentage of non-CVDs — including cancer, diabetes, lower respiratory diseases and kidney disease — being the underlying cause rose from 29.4% in 2000 to 34.9% in 2015 (P < .05 for both), they wrote.
“The shift in the distribution of the causes of death toward less ischemic heart disease is consistent with the results of a community-based study on [HF],” Ni and Xu wrote. “This finding is important for [HF] management approaches.” – by Erik Swain
Disclosure: Ni and Xu are employees of the CDC.
Perspective
Back to TopErin Coglianese, MD
Despite the fact that more attention is being paid to the risk factors associated with developing HF, like high BP and obesity, HF remains a significant problem due to an ongoing increase in incidence of HF in the elderly. The increase seen in HF-related mortality may be associated with the aging of our population.
The rise in HF-related mortality rates since 2012 is likely multifactorial and should be investigated further, but many researchers in the field think it is associated with the aging of the population and the increase in the incidence of HF in the elderly. It is interesting to note that there was a decrease in the number of in-hospital HF-related deaths. This means more patients are dying in nursing homes and at home, potentially with hospice. This really implicates the chronic nature of the disease. We are doing a better job managing the acutely ill hospitalized patient, but have perhaps less to offer to the chronically ill patient. This is something that requires further research.
We also need to continue to focus on reducing the risk factors associated with HF, like hypertension and obesity. We need to do a much better job understanding why there is an ongoing difference in mortality between African American and Caucasian patients and strive to close the gap.
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