As the US Ages, Uptick Seen in Number of Deaths Due to Heart Disease

New research is highlighting what threatens to become a public-health crisis—as the age of the US population rises, so too will the absolute number of people dying from heart disease. The situation is particularly dire when it comes to heart failure, researchers found. Four in five adults who died of heart disease were age 65 or older in their data set, which covered 2001 to 2017.

Although mortality related to heart disease has continued to decline in recent years, those gains have been leveling off thanks to diabetes and obesity. Now age is entering the mix.

These numbers speak to the “Silver Tsunami” that’s already occurring, senior author Jamal S. Rana, MD, PhD (Kaiser Permanente Northern California, Oakland), told TCTMD. “As practitioners,” he said, “we are seeing more and more in our emergency rooms and hospitals that older patients are getting sicker and sicker. You are seeing this shift in the age group [to whom] you’re providing care.”

This rise in demand translates into greater strain on the healthcare system and is a “burden we’re bracing for,” Rana observed.

CDC Database

For their study published online last week in JAMA Cardiology, lead author Stephen Sidney, MD, MPH (Kaiser Permanente Northern California), and colleagues used a Centers for Disease Control and Prevention database to chart national changes in the number of US adults age 65 and older as well as patterns in heart-disease death from 2001 to 2017.

This segment of the US population grew by 22.9% over the study period, from 41.4 million to 50.9 million. By comparison, the number of adults younger than 65 increased by just 1.7%. “The population of adults aged 65 years and older is projected to increase to 73.1 million by 2030,” the investigators note.

Between 2001 and 2017, the age-adjusted mortality rate decreased by 5.0% for heart disease as a whole and 14.9% for coronary heart disease (CHD). For heart failure and “other” heart diseases, the rate grew by 20.7% and 8.4%, respectively, across the years. The actual number of deaths rose by 8.5% for all heart disease as well as by 38.0% for heart failure and 23.4% for “other.” For CHD, the number of deaths decreased by 2.5%.

Highlighting heart failure mortality’s rapid rise, Sidney et al point out that the situation will worsen: between 2015 and 2030, the prevalence of heart failure nationally is projected to increase by 37% overall and by 57% in adults age 65 and up.

Shifts in the US population are “expected to create challenges for the capacity of public health and medical care efforts to prevent and manage heart disease. Innovative and effective approaches for surveillance, prevention, and treatment are needed to address the expanding burden of heart disease mortality, particularly for the substantially increasing rates of heart failure,” they conclude.

To TCTMD, Rana explained that the increase in heart failure relates to the fact that “a lot of patients are actually surviving their heart attacks. They are living longer, but then they are living with heart failure and more chronic diseases and eventually dying of that. So the overall burden is on the rise.”

What this suggests is that, beyond acute coronary events like MI, chronic heart failure also merits focused attention when it comes to prevention, surveillance, and policy-making, he said. Especially concerning for Rana is heart failure with preserved ejection fraction, because, as noted in the paper, “no proven disease-modifying therapies currently exist.”