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Posted: March 11, 2008

Heart Failure No Longer Death Sentence; More Elderly Live With It

The number of elderly newly diagnosed with heart failure has dropped during the past 10 years, but the number of those actually surviving with the condition has increased, according to a report in the journal Archives of Internal Medicine.

"Heart failure affects nearly five million people in the United States, and more than 300,000 die each year as a result of the disease. Heart failure is primarily a disease of elderly persons and, consequently, places a significant and growing economic burden on the Medicare program," according to background information in the article.

Heart failure occurs when the heart can’t pump blood the way it should. In some cases, the heart can’t fill with enough blood. In other cases, the heart can’t send blood to the rest of the body with enough force. Some people have both problems. However, heart failure doesn’t mean that your heart has stopped or is about to stop working.

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The number of people age 65 or older hospitalized for heart failure from 1984 to 2002 rose by more than 30%. "Estimates of the incidence [rate of new cases] and prevalence [percentage of the population affected] of heart failure in elderly persons translate directly into projections of resource use for the Medicare program, so accurate estimates are essential."

Lesley H. Curtis, Ph.D., of the Duke University School of Medicine in Durham, North Carolina, and colleagues analyzed the files of 622,789 Medicare patients age 65 or older who were diagnosed with heart failure between 1994 and 2003. Their purpose was to measure the rate of new heart failure occurrences and the number of people living with heart failure.

The yearly occurrence of heart failure dropped from 32 per 1,000 person-years (years of observation time during which each person is at risk to develop the disease) in 1994 to 29 per 1,000 person-years in 2003. A sharper decline was seen in Medicare patients age 80 to 84 (from 57.5 to 48.4 per 1,000 person-years), while a slight increase was seen in those age 65 to 69 (from 17.5 to 19.3 per 1,000 person-years).

The number of patients living with the condition increased steadily from about 140,000 to approximately 200,000 with more men living with the disease than women each year. "The proportion of beneficiaries with a heart failure diagnosis grew from 90 per 1,000 in 1994 to 120 per 1,000 in 2000, and remained at about 120 per 1,000 through 2003," the authors write.

"Although the incidence [new cases] 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," the authors conclude. "Identifying optimal strategies for the treatment and management of heart failure will become increasingly important as the size of the Medicare population grows."

This study was supported in part by a grant from the National Institute on Aging; a grant from the National Heart, Lung and Blood Institute; a grant from the Agency for Healthcare Research and Quality, and a research agreement between Medtronic and Duke University.

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