Decline in heart failure deaths has been undone, led by people under 45

🌈 Abstract

The article discusses the concerning trend of increasing heart failure mortality rates in the United States, reversing a previous decline. It highlights key findings, including:

• Heart failure death rates have been steadily rising since 2012, with a significant acceleration during the COVID-19 pandemic.
• The death rate for people under 45 spiked 906% between 1999 and 2021, compared to smaller increases for older age groups.
• Factors contributing to the worsening trend include the persistence of risk factors like obesity, diabetes, and health inequities, as well as the impact of COVID-19.
• However, the article also notes the availability of newer medications that have shown promise in improving heart health and the potential to offset the recent increase in mortality.

🙋 Q&A

[01] Heart Failure Mortality Trends

1. What are the key findings regarding heart failure mortality trends in the United States?

• Heart failure mortality rates have been moving in the wrong direction, reversing a previous decline.
• Death rates steadily dropped until 2012, then plateaued and began to rise, with a significant acceleration during the COVID-19 pandemic.
• The death rate for people under 45 spiked 906% between 1999 and 2021, compared to smaller increases of 364% for ages 45-64 and 84% for those 65 and older.

2. What are some potential explanations for the worsening heart failure mortality trends?

• The persistence of risk factors like obesity, high blood pressure, diabetes, and physical inactivity, which have been getting worse over the last few decades.
• The persistence of health inequities, which will require both public policy and medical/lifestyle interventions to address.
• The outsized influence of the COVID-19 pandemic, the effects of which are not yet fully understood.

3. How have improvements in diagnosis and treatment affected the data?

• Better recognition and diagnosis of heart failure may have contributed to increased prevalence in the data.
• More people are surviving heart attacks and living long enough to develop heart failure, which could explain higher rates in recent years.
• The data may not accurately capture the cause of death, as heart failure may be cited when cardiac arrest was the actual cause (e.g., in opioid overdoses).

[02] Emerging Treatments and Future Outlook

1. What new medications are showing promise for heart failure treatment?

• Newer obesity drugs developed for diabetes treatment have also been proven effective in improving heart health.
• These new medications appear to work for heart failure patients across the range of ejection fraction.

2. What is the potential impact of these new medications on the recent worsening of heart failure mortality?

• There is hope that these new medications can offset the recent increase in cardiovascular mortality.
• However, the article notes the need to improve systems of care delivery to ensure patients can access and receive these medications.

3. How do the experts view the current state and future outlook for heart failure treatment and outcomes?

• The experts express a sense of both concern and optimism, noting that while the recent trends are troubling, there is also reason for hope with the availability of better medications and the potential to improve care delivery.
• One expert states that the situation represents "a new day" for those focused on heart failure, moving from limited opportunities to offer hope to a scenario where true improvement is realistically possible.