Heart Failure as a Growing Public Health Crisis, with Muthiah Vaduganathan, MD, MPH

Muthiah Vaduganathan, MD, MPH
Credit: Brigham and Women's Hospital

Less than a week before the organization’s annual scientific meeting, the Heart Failure Society of America released a new special report highlighting concerning trends for the future of heart failure management.

Named HF Stats (SM), the initiative calls attention to statistical trends in epidemiology and outcome of heart failure using contemporary data and will also include the launch of a searchable online database and website housing graphics as well as citations for researchers wishing to cite these statistics.

“The inaugural HF Stats (SM) report has uncovered some truly remarkable and sobering data about the state of heart failure in the U.S. and around the world,” said Biykem Bozkurt, MD, PhD, of the Baylor College of Medicine and chair of the HFSA Data in Heart Failure Committee. “As providers, we are all doing our best to take care of our patients living with heart failure, but it's clear that more work needs to be done on early prevention, recognition, and treatment of our patients to reduce mortality and rehospitalizations. Myself and others volunteering in HFSA leadership positions look forward to using HF Stats (SM) data to create new programs and interventions to address these issues in an effort to reverse these statistics.”

With the intention to release the report annually, the inaugural edition of the document is aimed at providing a clear and comprehensive synthesis of trends in heart failure epidemiology and outcomes as a foundation for clinical care, resource allocation, and research, to address differences in heart failure epidemiology and outcomes according to sex, race, ethnicity, and age, to identify current knowledge gaps and limitations in heart failure epidemiologic data, and to forecast the future impact and burden of heart failure.

Highlighted within the report, which was published in the Journal of Cardiac Failure, were 10 key points:

1. Approximately 6.7 million Americans over 20 years of age have heart failure, and the prevalence is expected to rise to 8.5 million Americans by 2030.
2. The lifetime risk of heart failure has increased to 24%; approximately 1 in 4 persons will develop heart failure in their lifetime.
3. Approximately 33% of the US adult population is at-risk for heart failure and 24-34% of the US population have pre-heart failure. The risk of developing heart failure in individuals with obesity and hypertension has increased.
4. The incidence and prevalence of heart failure is higher among Black individuals compared with other racial and ethnic groups. The prevalence of heart failure has increased among Black and Hispanic individuals over time.
5. Heart failure mortality rates have been increasing since 2012.
6. Black, American Indian, and Alaska Native individuals have the highest all-cause age-adjusted heart failure mortality rates compared with other racial and ethnic groups. From 2010 to 2020, heart failure mortality rates have increased for Black women and men at a rate higher than any other racial or ethnic groups, particularly for individuals below the age of 65.
7. A greater relative annual increase in heart failure-related mortality rates has been noted for younger compared with older adults.
8. Highest heart failure death rates have been reported in the Midwest, Southeast, and Southern states. Rural areas demonstrate higher heart failure mortality rates for both younger and older age groups compared with urban areas.
9. Rates of heart failure hospitalizations have increased from 2014 to 2017. This increase was consistent between age groups and sexes, with the highest rates being among Black patients.
10. Disparities in social determinants of health and health inequities are important heart failure risk factors and result in increased mortality and other adverse outcomes in individuals at risk for heart failure or with heart failure.

To highlight this report and the growing emphasis on implementation science in heart failure, HCPLive Cardiology sat down with one of the report’s authors Muthiah Vaduganathan, MD, MPH, codirector of the Center for Cardiometabolic Implementation Science, for further perspective on the document.

HCPLive Cardiology: Can you talk about the onus behind this report and touch on what makes this unique relative to some of the annual reports we see from other organizations on cardiovascular disease statistics?

Vaduganathan: This was a special report from the Heart Failure Society of America and really helps prioritize heart failure, amongst other common conditions, so that we have the same sense of urgency and same sense of action that we undertake in clinical practice. This was a unique report and, with that, the writing group really was represented by a number of not only thought leaders, but also experts in data science, epidemiology, and clinical medicine and so many of those individuals were able to contribute unique aspects to building the picture of heart failure today.

HCPLive Cardiology: In the heart failure landscape, the advancement in pharmacology stands in stark contrast to the uptake and optimal management. How is this reflected in the report?

Vaduganathan: I think that we have this very unique moment in heart failure care in which we're in almost a golden era of heart failure therapeutics and innovation. Yet, we see such sobering statistics like this, where the global and US burden of heart failure remains as high as ever. So, I think that this juxtaposition really puts into context, the need for effective implementation, and implementation. That's not only complete, but also that's equal across groups. Because one of the key aspects to this report was to highlight key disparities in care across multiple levels.

HCPLive Cardiology: How important are more focused meetings, like HFSA, as it pertains to implementation science?

Vaduganathan: I think HFSA is such a unique meeting and why I love it is that it really is a multidisciplinary forum. You will not find a meeting that has such diverse representation across clinical medicine and because of that, the people actually caring for heart failure at the bedside and in the clinic are here. With that, these discussions can take place and implementation science can move from theory to practice.