Rates of HF, common cancers similar in socioeconomically deprived patients

The prevalence of HF increased from 2002 to 2014 in the U.K., especially in those who were socioeconomically deprived, according to an analysis published in The Lancet.

The number of new HF cases in 2014 was similar to the number of new cases of common cancers that year.

“The disparities we have identified in the U.K. point to a potentially preventable nature of heart failure that still needs to be tackled, and to potential opportunities for more targeted and equitable prevention strategies,” Kazem Rahimi, FRCP, DM, MSc, FESC, deputy director of The George Institute for Global Health at the University of Oxford, said in a press release. “Achieving equal access and use of health care is an important goal, and in this instance could help to tackle the biological, environmental and behavioral risk factors that put people from more deprived background at greater risk of heart failure.”

UK data analysis

Nathalie Conrad, MS c , a PhD student at the University of Oxford, and colleagues analyzed data from 4,045,144 patients aged at least 16 years from the U.K. Clinical Practice Research Datalink. Information such as electronic health records, baseline characteristics within 2 years of an HF diagnosis, socioeconomic status, comorbidities, geographical region and ethnicity were included in the analysis. Patients with an HF diagnosis before the study or within the first year of registering with their general practice were excluded.

Of the patients from the cohort, 93,074 (mean age, 77 years; 49% women) were diagnosed with incident HF. The mean age at HF diagnoses increased from 76.5 years in 2002 to 77 years in 2015 (adjusted difference = 0.79 years; 95% CI, 0.37-1.2). The mean number of comorbidities was 3.4 in 2002 and 5.4 in 2014 (adjusted difference = 2; 95% CI, 1.9-2.1).

After adjusting for age and sex, HF incidence decreased by 7% from 2002 (358 per 100,000 people) to 2014 (332 per 100,000 people; adjusted incidence rate ratio (IRR) = 0.93; 95% CI, 0.91-0.94). This was consistent across most age groups except in patients aged at least 85 years.

The estimated absolute number of annual new HF diagnoses increased by 12%, from 170,727 in 2002 to 190,798 in 2017, which was attributed to a growing and aging population. The number of new HF diagnoses were similar to new cases of breast, lung, prostate and bowel cancers combined in 2014 (n = 189,136).

Patients living with HF increased by 23%, from 1.3% of the total population in 2002 to 1.4% in 2014.

Socioeconomic disparities

Those who were socioeconomically deprived were more likely to be about 3.5 years younger (adjusted difference = –3.51; 95% CI, –3.77 to –3.25) when diagnosed with incident HF (IRR = 1.61; 95% CI, 1.58-1.64).

The socioeconomic gradient for the age at first HF presentation widened from 2002 to 2014. Patients who were socioeconomically deprived had more comorbidities, even at a younger age.

“The profile of patients with heart failure is diverse and evolving over time — with a trend toward older age and a substantial increase in the number of associated comorbidities — indicating that both prevention and management are becoming more complex,” Conrad and colleagues wrote. “The observed disparities in heart failure incidence by sex, socioeconomic status and region point to potential opportunities for more targeted and equitable prevention strategies.”

In a related editorial, Faiez Zannad, MD, PhD, professor of therapeutics and cardiology, director of the Clinical Investigation Centre at Inserm in Paris and head of the heart failure and hypertension unit at CHU and University Henri Poincaré in Nancy, France, wrote: “Although prevention is often touted as a means to combat heart failure, effective prevention strategies have clearly not been widely embraced, suggesting that the approach to prevention also needs to evolve. Mechanistic bioprofiling of patients (ie, selecting subgroups of patients on the basis of biomarker profiles, which are indicative of underlying mechanisms that are more specifically activated in those with heart failure) and matching preventive strategies to mechanistic biotargets could hold future promise for more effective implementation of heart failure prevention strategies.” – by Darlene Dobkowski

Disclosures: Conrad and Rahimi report no relevant financial disclosures. Zannad reports he received steering committee fees from AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, CVRx, General Electric, Janssen, Novartis, Pfizer, Resmed and Takeda; consulting fees from Amgen, AstraZeneca, Quantum Genomics, Relypsa, Roche Diagnostics, Vifor Fresenius and ZS Pharma; and is a co-founder with equity of Cardiorenal and a founder with equity of CVCT.