Heart Failure Trends Have Shifted Over 30 years

The prevalence of heart failure with reduced ejection fraction (HFrEF) has decreased over the last 30 years, according to the findings of a recent study.

In their analysis, the researchers examined the prevalence of left ventricular systolic dysfunction (LVSD) among participants with and without heart failure (HF) involved in the Framingham Study from 1985 to 2014.
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Overall, they found that the prevalence of LVSD decreased among participants without HF, from 3.38% in 1985 to 1994 to 2.2% in 2005 to 2014. Likewise, the mean left ventricular ejection fraction (LVEF) increased from 65% to 68%. LVSD was associated with a 2-fold to 4-fold increase in the risk for heart failure or death, which remained unchanged over time.

Among participants with new-onset HF, HFrEF decreased while heart failure with preserved ejection fraction (HFpEF) increased. However, HF with midrange LVEF remained unchanged.  

Only cardiovascular-related mortality associated with HFrEF declined across the 3 decades of follow-up, while mortality associated with HF with midrange LVEF and HFpEF remained the same.

In addition, the researchers attributed trends in risk factors, such as the decline in the prevalence of coronary heart disease among individuals with HF, to approximately 47% of the observed increases in LVEF among those without HF and the 75% rise in the proportion of HFpEF.

“The profile of HF in the community has changed in recent decades, with a lower prevalence of LVSD and an increased frequency of HFpEF, presumably due to concomitant risk factor trends,” the researchers concluded.

—Melissa Weiss

Reference:

Vasan RS, Xanthakis V, Lyass A, et al. Epidemiology of left ventricular systolic dysfunction and heart failure in the Framingham Study [published online September 13, 2017]. ACC Cardiovasc Imaging. doi:10.1016/j.jcmg.2017.08.007.