Background: To assess the current landscape of the heart failure epidemic and provide targets for future health policy interventions in Medicare, a contemporary appraisal of the epidemiology of heart failure across inpatient and outpatient care settings is needed.
Methods: In a 5% sample of Medicare, 2,331,939 unique fee-for-service Medicare beneficiaries (≥65 years) were followed for all inpatient and outpatient encounters over a 10-year period (2004-2013). Pre-existing HF was defined by any HF encounter (inpatient/outpatient) at study entry, and incident HF by either one inpatient or two outpatient encounters.
Results: At study entry, mean age of the cohort was 72 years; 57% were women, and 86% and 8% were White and Black, respectively. Overall, 518,223 patients had pre-existing heart failure, and among those without pre-existing disease, 349,826 had a new diagnosis of heart failure during the study-period. During 2004-2013, the rates of incident heart failure declined 32%, from 38.7 per 1000 beneficiaries during 2004 to 26.2 per 1000 beneficiaries during 2013. Similar trends were observed in demographics subgroups by age, sex (men/women), race/ethnicity (white/black) and US Census regions, with advanced age, male sex and black race associated with the highest incidence of heart failure. In contrast to incident disease, prevalent heart failure increased during our study period from 162 per 1000 in 2004 to 172 per 1000 beneficiaries during 2013 (Fig A-B). Finally, the overall 1-year mortality among patients with incident heart failure is high (24.7%) with a 0.4% absolute decline annually during the study period, with å more pronounced decrease among those diagnosed in an inpatient vs outpatient setting (P-interaction <.001) (Fig C-D).
Conclusions: There has been a substantial decline in incident HF in Medicare beneficiaries across healthcare settings, however, 1-year HF mortality continues to be high, and the overall burden of HF is still increasing.