Trends in Hospitalizations and Survival of Acute Decompensated Heart Failure in Four US Communities (2005-2014): The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance
Background—Community trends of acute decompensated heart failure (ADHF) in diverse populations may differ by race and sex.
Methods—The Atherosclerosis Risk in Communities (ARIC) Study sampled heart failure related hospitalizations (age ≥55 years) in four US communities from 2005-2014 using ICD-9-CM codes. ADHF hospitalizations were validated by standardized physician review and computer algorithm, yielding 40,173 events after accounting for sampling design (unweighted n=8746).
Results—Of the ADHF hospitalizations, 50% had reduced ejection fraction (HFrEF), 39% had preserved EF (HFpEF). HFrEF was more common in black men and white men, whereas HFpEF was most common in white women. Average age-adjusted rates of ADHF was highest in blacks (38.1 per 1000 black men, 30.5 per 1000 black women), with rates differing by HF type and sex. ADHF rates increased over the 10 years (average annual percent change, AAPC: black women +4.3%, black men +3.7%, white women +1.9%, white men +2.6%), mostly reflecting more acute HFpEF. Age-adjusted 28-day and 1-year case fatality proportions were approximately 10% and 30%, respectively, similar across race-sex groups and HF types. Only blacks showed decreased 1-year mortality over time (AAPC: black women -5.4%, black men -4.6%), with rates differing by HF type (AAPC: black women HFpEF -7.1%, black men HFrEF -4.7%).
Conclusions—Between 2005-2014, trends in ADHF hospitalizations increased in four US communities, primarily driven acute HFpEF. Survival at one year was poor regardless of EF, but improved over time for black women and black men.
- Received January 25, 2017.
- Revision received February 2, 2018.
- Accepted February 20, 2018.