Introduction: Dementia complicates the management of heart failure and may be associated with higher risk for death and readmission. Dementia and heart failure also share pathophysiologic risk factors with a potential for common disease modifying therapies. Yet, little is known about the burden of combined heart failure and dementia in the US. Our objective was to 1) estimate the burden of heart failure and dementia mortality in the US and 2) characterize the demographics of affected individuals.
Methods: We studied deaths with both ICD 10 codes anywhere on the death certificate for ‘heart failure’ and ‘Alzheimer’s disease, related disorders, and senile dementia’ as defined by the Medicare Chronic Conditions Data Warehouse (CCW). Data were obtained from multiple cause of death public-use data files (1999-2015) at CDC WONDER. Mortality rates were calculated and age-adjusted to a 2000 United States standard population.
Results: Between 1999-2015, 200,862 individuals died from heart failure and dementia (3.69 deaths/100,000 US population, 95% CI: 3.67-3.70). Majority of deaths occurred in women (69.1%, 138, 846 deaths, risk ratio women to men: 1.18) and elderly >85 years (74.6%, N=149,820, risk ratio >85 to 75-84 years: 8.54). White Americans were the most at risk of mortality from heart failure and dementia (92.2%, 185, 261 deaths), followed by Black Americans, and others; mortality was higher among White and Black American women compared to men (Figure). However, in populations under 75 years, Black Americans had higher mortality rate from heart failure and dementia (risk ratio Black Americans to White Americans: 1.11). The highest death rate was reported in Mississippi with 8.00 deaths/100,000 (95% CI: 7.75-8.25).
Conclusions: Dementia with heart failure contributes to considerable mortality in the elderly, white Americans, and women more than men; this entity merits further investigation with regards to shared pathophysiology and novel treatment strategies.