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Lesley H. Curtis, PhD; David J. Whellan, MD, MHS; Bradley G. Hammill, MS; Adrian F. Hernandez, MD, MHS; Kevin J. Anstrom, PhD; Alisa M. Shea, MPH; Kevin A. Schulman, MD

Arch Intern Med. 2008;168(4):418-424.

Background  Recent analyses have presented conflicting evidence regarding the incidence and prevalence of heart failure in the United States. We sought to estimate the annual incidence and prevalence of heart failure and associated survival in elderly persons from January 1, 1994, through December 31, 2003.

Methods  We conducted a retrospective cohort study of 622 789 Medicare beneficiaries 65 years or older who were diagnosed as having heart failure between 1994 and 2003. The main outcome measures were incidence and prevalence of heart failure and survival following a heart failure diagnosis.

Results  The incidence of heart failure declined from 32 per 1000 person-years in 1994 to 29 per 1000 person-years in 2003 (P < .01). Incidence declined most sharply among beneficiaries aged 80 to 84 years (from 57.5 to 48.4 per 1000 person-years, P < .01) and increased slightly among beneficiaries aged 65 to 69 years (from 17.5 to 19.3 per 1000 person-years, P < .01). Although risk-adjusted mortality declined slightly from 1994 to 2003, the prognosis for patients diagnosed as having heart failure remains poor. In 2002, risk-adjusted 1-year mortality was 27.5%, more than 3 times higher than for age- and sex-matched patients.

Conclusions  Although the incidence of heart failure has declined somewhat during the past decade, modest survival gains have resulted in an increase in the number of patients living with heart failure. Identifying optimal strategies for the treatment and management of heart failure will become increasingly important as the size of the Medicare population grows.

Author Affiliations: Center for Clinical and Genetic Economics (Drs Curtis, Anstrom, and Schulman, Mr Hammill, and Ms Shea) and Outcomes Research and Assessment Group (Dr Anstrom), Duke Clinical Research Institute (Drs Whellan and Hernandez), and Departments of Medicine (Drs Curtis, Whellan, Hernandez, and Schulman) and Biostatistics and Bioinformatics (Dr Anstrom), Duke University School of Medicine, Durham, North Carolina; and Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Whellan).

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