HFSA Stats 2024 a ‘Call to Action’ Against Rising Tide of HF

Heart failure (HF) is growing more common in the United States, with staggering numbers predicted in the next 25 years and spikes in the incidence of the disease among younger individuals, racial and ethnic minority groups, and those with comorbid conditions, according to a report from the Heart Failure Society of America (HFSA).

Currently, about 6.7 million Americans over age 20 have HF. The report suggests that 2 million more will be added within the next 6 years, with a projected HF incidence by 2050 of 11.4 million people.

The reality, said writing committee chair Biykem Bozkurt, MD, PhD (Baylor College of Medicine, Houston, TX), is that one in four individuals risk getting heart failure over the course of a lifetime, and that HF mortality rates are worsening, particularly in Black adults, in whom they are higher than in any other racial or ethnic group.

She said the prevalence data in the report are important because in the United States, much of the appropriation of funding and support is based on disease burden and magnitude in the population.

“We think there is a mismatch in the burden of heart failure and the appropriation of funds for research, implementation, infrastructure, and care coordination,” Bozkurt noted. Without appropriate funding for implementation, it falls on the shoulders of clinicians, adding to an already burdened workforce.

“Unfortunately, in HF we have a lack of the type of seamless coordination and delivery of care that you see in cancer care, for example, where there is usually an expectation that a patient will receive complete chemotherapy, not partial therapy,” Bozkurt added. “And usually there is an urgency in the implementation of those therapies. Heart failure is as deadly as cancer is, more prevalent than cancer is, and the prevalence and mortality rates are increasing.”

Troubling Trends

The 2024 report, published last week in the Journal of Cardiac Failure, is the second annual look at trends around the United States for HF epidemiology and outcomes.

According to Bozkurt and colleagues, approximately 33% of US adults are at risk for HF, while another 24-34% have pre-HF. The report also notes that:

• Since 2012, HF has been on the rise, with higher age-adjusted mortality rates seen in 2021 than in 1999
• Black, American Indian, and Alaskan Native individuals have the highest all-cause age-adjusted HF mortality rates of any racial/ethnic group
• From 2010 to 2020, HF mortality rates in Black individuals increased at a rate higher than any other racial/ethnic group, particularly in those younger than age 65
• People in the 35-to-64 age range have had a more pronounced annual increase in HF-related mortality than those aged 65 to 84
• The states with the highest age-adjusted prevalence of HF are Michigan, New York, Indiana, Kentucky, and Oklahoma
• HF mortality rates have been increasing since 2012, with the highest found in the Midwest, Southeast, and Southern states, and with higher mortality in rural areas in both younger and older individuals compared with urban areas
• Since 2014, HF hospitalizations have been on the rise and appear consistent between age groups and sexes, with the highest rates see in Black patients
• Compared with the general population, individuals aged 65 to 85 who have HF lose 7 to 15 years of median survival
• Estimates project an increase in total HF costs from $138 billion in 2020 to $420 billion by 2050

Bozkurt and colleagues say the reasons behind the increasing HF-related mortality are unclear, but note that a likely contributor is that implementation of guideline-directed medical therapy (GDMT) has fallen short.

Heart failure is as deadly as cancer is, more prevalent than cancer is, and the prevalence and mortality rates are increasing. Biykem Bozkurt

To TCTMD, Bozkurt said despite data showing clinical inertia plays a significant role, the issue likely goes much deeper in the form of a learned helplessness where time constraints and an overloaded healthcare system often work against timely implementation and follow-up care requirements.

She added that efforts are needed to create “an incentivization model for complete or comprehensive care,” in order for the structure of HF therapy to evolve beyond its current state.

“Furthermore, comprehensive population-based registries and outcome studies targeting populations at risk for HF, pre-HF stages, HF stages, including when patients reach advanced HF are lacking,” the document notes. “These studies should also investigate specific etiologies of HF and cardiomyopathies, different EF subgroups, and take into account factors such as race/ethnicity, sex, gender, geography, social determinants of health, access and coverage in healthcare, and structural inequities.”

Bozkurt said the report represents “a call to action” from the HF community.

“We need more awareness and multistakeholder intervention,” she said. “Access to care needs to be ascertained, proximity to care needs to be ascertained, coverage should be ascertained, and life-saving therapies should be covered with affordable medications and or interventions. We need equity for all.”