Incidence and Survival of Hospitalized Acute Decompensated Heart Failure in Four US Communities (from the Atherosclerosis Risk in Communities Study)

doi:10.1016/j.amjcard.2013.10.032

The American Journal of Cardiology

Volume 113, Issue 3, 1 February 2014, Pages 504-510

https://doi.org/10.1016/j.amjcard.2013.10.032 Get rights and content

Most population-based estimates of incident hospitalized heart failure (HF) have not differentiated acute decompensated heart failure (ADHF) from chronic stable HF nor included racially diverse populations. The Atherosclerosis Risk in Communities Study conducted surveillance of hospitalized HF events (age ≥55 years) in 4 US communities. We estimated hospitalized ADHF incidence and survival by race and gender. Potential 2005 to 2009 HF hospitalizations were identified by International Classification of Diseases, Ninth Revision, Clinical Modification, codes; 6,168 records were reviewed to validate ADHF cases. Population estimates were derived from US Census data; 50% of eligible hospitalizations were classified as ADHF, of which 63.6% were incident ADHF and 36.4% were recurrent ADHF. The average incidence of hospitalized ADHF was 11.6 per 1,000 persons, aged ≥55 years, per year, and recurrent hospitalized ADHF was 6.6 per 1,000 persons/yr. Age-adjusted annual ADHF incidence was highest for black men (15.7 per 1,000), followed by black women (13.3 per 1,000), white men (12.3 per 1,000), and white women (9.9 per 1,000). Of incident ADHF events with heart function assessment (89%), 53% had reduced the ejection fraction (heart failure with reduced ejection fraction [HFrEF]) and 47% had preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF]). Black men had the highest proportion of acute HFrEF events (70%); white women had the highest proportion of acute HFpEF (59%). Age-adjusted 28-day and 1-year case fatality after an incident ADHF was 10.4% and 29.5%, respectively. Survival did not differ by race or gender. In conclusion, ADHF hospitalization and HF type varied by both race and gender, but case fatality rates did not. Further studies are needed to explain why black men are at higher risk of hospitalized ADHF and HFrEF.

Section snippets

Methods

The 4 ARIC study communities include Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland. Average gender- and race-specific population estimates for each study community were computed for 2005 to 2009 by extrapolations from the 2000 and 2010 US censuses. The estimated population size aged ≥55 years were Forsyth County, 395,782 (20.8% black); Jackson, 171,241 (60.9% black); Minneapolis suburbs, 253,225; and Washington County, 174,414.

Results

Of the 42,413 HF-eligible hospitalizations, 41.2% were validated as ADHF, 9.0% as chronic HF, and 49.8% were classified as no HF; the most common ICD-9-CM discharge code was 428.xx (congestive HF, 89.1%). Of the validated hospitalized HF events, 82% were ADHF; 76.7% had either previous outpatient diagnosis of HF (73.4%) or treatment for HF (64.9%).

Of hospitalized ADHF events, 63.6% were incident hospitalized ADHF (53.2% of which had previous HF diagnosis) and 36.4% were recurrent events.

Discussion

We found that ADHF hospitalization rates and HF type varied by race and gender, whereas CF did not. The ARIC study is unique because it differentiates ADHF from chronic stable HF, contributing more specificity than older classification criteria (e.g., Framingham) and ICD-9-CM codes.⁵ In addition, the ARIC communities are relatively racially diverse allowing for evaluation of event rates among whites and blacks. Black men had the highest incidence and recurrence rates of hospitalized ADHF,

Acknowledgment

The authors thank the staff and participants of the ARIC study for their important contributions.

References (30)

S.M. Dunlay et al.
Hospitalizations after heart failure diagnosis a community perspective
J Am Coll Cardiol
(2009)
G.A. Haldeman et al.
Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995
Am Heart J
(1999)
G.D. Schellenbaum et al.
Congestive heart failure incidence and prognosis: case identification using central adjudication versus hospital discharge diagnoses
Ann Epidemiol
(2006)
L. Djousse et al.
Secular trends of heart failure among US male physicians
Am Heart J
(2007)
L.R. Loehr et al.
Heart failure incidence and survival (from the Atherosclerosis Risk in Communities Study)
Am J Cardiol
(2008)
R.J. Goldberg et al.
Epidemiology of decompensated heart failure in a single community in the northeastern United States
Am J Cardiol
(2009)
E. Shahar et al.
Hospitalized heart failure: rates and long-term mortality
J Card Fail
(2004)
R.J. Goldberg et al.
Incidence and hospital death rates associated with heart failure: a community-wide perspective
Am J Med
(2005)
N.K. Sweitzer et al.
Comparison of clinical features and outcomes of patients hospitalized with heart failure and normal ejection fraction (> or =55%) versus those with mildly reduced (40% to 55%) and moderately to severely reduced (<40%) fractions
Am J Cardiol
(2008)
C.W. Yancy et al.
Quality of care of and outcomes for African Americans hospitalized with heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry
J Am Coll Cardiol
(2008)

K.L. Thomas et al.

Association of race/ethnicity with clinical risk factors, quality of care, and acute outcomes in patients hospitalized with heart failure

Am Heart J

(2011)

A.D. White et al.

Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) study: methods and initial two years' experience

J Clin Epidemiol

(1996)

V.L. Roger et al.

Heart disease and stroke statistics—2011 update: a report from the American Heart Association

Circulation

(2011)

M.M. Redfield et al.

Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic

JAMA

(2003)

F. Bursi et al.

Systolic and diastolic heart failure in the community

JAMA

(2006)

Cited by (89)

Mechanistic target of rapamycin in regulating macrophage function in inflammatory cardiovascular diseases
2024, Journal of Molecular and Cellular Cardiology
The mechanistic target of rapamycin (mTOR) is evolutionarily conserved from yeast to humans and is one of the most fundamental pathways of living organisms. Since its discovery three decades ago, mTOR has been recognized as the center of nutrient sensing and growth, homeostasis, metabolism, life span, and aging. The role of dysregulated mTOR in common diseases, especially cancer, has been extensively studied and reported. Emerging evidence supports that mTOR critically regulates innate immune responses that govern the pathogenesis of various cardiovascular diseases. This review discusses the regulatory role of mTOR in macrophage functions in acute inflammation triggered by ischemia and in atherosclerotic cardiovascular disease (ASCVD) and heart failure with preserved ejection fraction (HFpEF), in which chronic inflammation plays critical roles. Specifically, we discuss the role of mTOR in trained immunity, immune senescence, and clonal hematopoiesis. In addition, this review includes a discussion on the architecture of mTOR, the function of its regulatory complexes, and the dual-arm signals required for mTOR activation to reflect the current knowledge state. We emphasize future research directions necessary to understand better the powerful pathway to take advantage of the mTOR inhibitors for innovative applications in patients with cardiovascular diseases associated with aging and inflammation.
Effect of Sotagliflozin on Early Mortality and Heart Failure-Related Events: A Post Hoc Analysis of SOLOIST-WHF
2023, JACC: Heart Failure
Approximately 25% of patients admitted to hospitals for worsening heart failure (WHF) are readmitted within 30 days.
The authors conducted a post hoc analysis of the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post-WHF) trial to evaluate the efficacy of sotagliflozin versus placebo to decrease mortality and HF-related events among patients who began study treatment on or before discharge from their index hospitalization.
The main endpoint of interest was cardiovascular death or HF-related event (HF hospitalization or urgent care visit) occurring within 90 and 30 days after discharge for the index WHF hospitalization. Treatment comparisons were by proportional hazards models, generating HRs, 95% CIs, and P values.
Of 1,222 randomized patients, 596 received study drug on or before their date of discharge. Sotagliflozin reduced the main endpoint at 90 days after discharge (HR: 0.54 [95% CI: 0.35-0.82]; P = 0.004) and at 30 days (HR: 0.49 [95% CI: 0.27-0.91]; P = 0.023) and all-cause mortality at 90 days (HR: 0.39 [95% CI: 0.17-0.88]; P = 0.024). In subgroup analyses, sotagliflozin reduced the 90-day main endpoint regardless of sex, age, estimated glomerular filtration rate, N-terminal pro-B-type natriuretic peptide, left ventricular ejection fraction, or mineralocorticoid receptor antagonist use. Sotagliflozin was well-tolerated but with slightly higher rates of diarrhea and volume-related events than placebo.
Starting sotagliflozin before discharge in patients with type 2 diabetes hospitalized for WHF significantly decreased cardiovascular deaths and HF events through 30 and 90 days after discharge, emphasizing the importance of beginning sodium glucose cotransporter inhibitor treatment before discharge.
Trends in Hospital Admissions for Systolic and Diastolic Heart Failure in the United States Between 2004 and 2017
2022, American Journal of Cardiology
Citation Excerpt :
In this nationally representative sample of systolic and/or diastolic HF hospitalizations in the United States from 2004 and 2017, there were approximately 60% admissions for systolic HF and 40% for diastolic HF. Recent publications have outlined an increase in the incidence of diastolic HF and a decrease in systolic HF over time, with an associated increase in the rate of hospitalization for diastolic HF.11–15 We found that even though the incidence of diastolic HF may be increasing, trends in hospitalizations from the NIS show an increase in the proportion of systolic HF admissions, with systolic HF accounting for 42% of the total HF admissions in 2004 and 63% in 2017.
Heart failure (HF) affects 6 million people in the United States and costs $30 billion annually. It is unclear whether improvements in length of stay and mortality over the last few decades hold true for both systolic and diastolic HF. To better assess the epidemiological and economic burden of HF, we assessed the trends in outcomes and costs for both systolic and diastolic HF. We identified hospitalizations for systolic and diastolic HF in the National Inpatient Sample database and evaluated trends over the period from 2004 to 2017, adjusting for demographics and co-morbidities. The proportion of patients admitted with an exacerbation of systolic HF increased from 42% to 63% over the study period. We found an overall decreasing trend between 2004 and 2011 in the length of stay for HF in general with a sharper decrease in diastolic than systolic HF. Inpatient mortality decreased between 2004 and 2007 and stabilized between 2008 and 2016. Systolic HF was associated with higher mortality than diastolic HF. The total inflation-adjusted cost did not change significantly over the study period, with systolic HF costing, on average, $3,036 more than diastolic HF per admission. In conclusion, systolic HF overtook diastolic HF, accounting for most HF hospitalizations in 2008. The higher hospitalization costs for systolic HF relative to diastolic HF may have resulted, in part, from greater use of advanced support devices in patients with systolic HF.
Race- and Gender-Based Differences in Cardiac Structure and Function and Risk of Heart Failure
2022, Journal of the American College of Cardiology
Although heart failure (HF) risk and cardiac structure/function reportedly differ according to race and gender, limited data exist in late life when risk of HF is highest.
The goal of this study was to evaluate race/gender–based differences in HF risk factors, cardiac structure/function, and incident HF in late life.
This analysis included 5,149 HF-free participants from ARIC (Atherosclerosis Risk In Communities), a prospective epidemiologic cohort study, who attended visit 5 (2011-2013) and underwent echocardiography. Participants were subsequently followed up for a median 5.5 years for incident HF/death.
Patients’ mean age was 75 ± 5 years, 59% were women, and 20% were Black. Male gender and Black race were associated with lower mean left ventricular ejection fraction. Black race was also associated with greater left ventricular wall thickness and concentricity, differences that persisted after adjusting for cardiovascular comorbidities. After adjusting for cardiovascular comorbidities, men were at higher risk for HF and heart failure with reduced ejection fraction (HFrEF) in Black participants compared with White participants (HF: HR of 2.36 [95% CI: 1.37-4.08] vs 1.16 [95% CI: 0.89-1.51], interaction P = 0.016; HFrEF: HR of 3.70 [95% CI: 1.72-7.95] vs 1.55 [95% CI: 1.01-2.37] respectively, interaction P = 0.039). Black race was associated with a higher incidence of HF overall and HFrEF in men only (HF: 1.65 [95% CI: 1.07-2.53] vs 0.76 [95% CI: 0.49-1.17]; HFrEF: HR of 2.55 [95% CI: 1.46-4.44] vs 0.91 [95% CI: 0.46-1.83]). No race/gender–based differences were observed in risk of incident heart failure with preserved ejection fraction.
Among older persons free of HF, men and Black participants exhibit worse systolic performance and are at heightened risk for HFrEF, whereas the risk of heart failure with preserved ejection fraction is similar across gender and race groups.
The ARIC (Atherosclerosis Risk In Communities) Study: JACC Focus Seminar 3/8
2021, Journal of the American College of Cardiology
ARIC (Atherosclerosis Risk In Communities) initiated community-based surveillance in 1987 for myocardial infarction and coronary heart disease (CHD) incidence and mortality and created a prospective cohort of 15,792 Black and White adults ages 45 to 64 years. The primary aims were to improve understanding of the decline in CHD mortality and identify determinants of subclinical atherosclerosis and CHD in Black and White middle-age adults. ARIC has examined areas including health disparities, genomics, heart failure, and prevention, producing more than 2,300 publications. Results have had strong clinical impact and demonstrate the importance of population-based research in the spectrum of biomedical research to improve health.
Characteristics, trends, outcomes, and costs of stimulant-related acute heart failure hospitalizations in the United States
2021, International Journal of Cardiology
Heart failure (HF) hospitalizations remains a significant burden on the health care system. Stimulants including cocaine, amphetamine and its derivatives are amongst the most used illegal substances in the United States. The information regarding stimulant-related HF hospitalizations is scarce. We sought to evaluate the characteristics and trends of stimulant-related HF hospitalizations in the United States and their associated outcomes and resource utilization.
Using the National Inpatient Sample (NIS), we identified patients with a primary diagnosis of HF hospitalization. These hospitalizations were further divided into those with and without a concomitant diagnosis of stimulant (cocaine or amphetamine) dependence or abuse. Survey specific techniques were employed to compare trends in baseline characteristics, complications, procedures, outcomes and resource utilization between the two cohorts.
We identified 9,932,753 hospitalizations (weighted) with a primary diagnosis of heart failure, of those 138,438 (1.39%) had a diagnosis of active stimulant use. The proportion of stimulant-related HF hospitalization is on the rise (1.1% to 1.9%). Stimulant-related HF hospitalization was highest amongst age group 30–39 years and 7.9% of HF hospitalizations in this age group were due to stimulant use. The proportion of stimulant-related HF hospitalization for the White and Hispanic race has doubled from 2008 to 2017. Stimulant-related HF hospitalization is associated with increased incidence of in-hospital complications like cardiogenic shock, acute kidney injury and ventricular tachycardia. These patients have more than 7-fold higher discharge against medical advice.
Stimulant-related HF hospitalizations have been increasing. It is associate with significant morbidity burden and health care utilization.

View all citing articles on Scopus

: The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (Bethesda, Maryland) contracts (HHSN268201100005 C, HHSN268201100006 C, HHSN268201100007 C, HHSN268201100008 C, HHSN268201100009 C, HHSN268201100010 C, HHSN268201100011 C, and HHSN268201100012 C).

: See page 509 for disclosure information.

View full text

Heart FailureIncidence and Survival of Hospitalized Acute Decompensated Heart Failure in Four US Communities (from the Atherosclerosis Risk in Communities Study)

Section snippets

Methods

Results

Discussion

Acknowledgment

J Am Coll Cardiol

Am Heart J

Ann Epidemiol

Am Heart J

Am J Cardiol

Am J Cardiol

J Card Fail

Am J Med

Am J Cardiol

J Am Coll Cardiol

Am Heart J

J Clin Epidemiol

Heart disease and stroke statistics—2011 update: a report from the American Heart Association

Circulation

Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic

JAMA

Systolic and diastolic heart failure in the community

JAMA

Heart Failure
Incidence and Survival of Hospitalized Acute Decompensated Heart Failure in Four US Communities (from the Atherosclerosis Risk in Communities Study)