Epidemiology And Etiology Epidemiology

HF is a major public health concern affecting approximately 5 million people in the United States. An additional 550,000 new cases are diagnosed each year. HF manifests most commonly in adults over the age of 60. The growing prevalence of HF corresponds to: (a) better treatment of patients with acute myocardial infarctions (MIs) who will survive to develop HF later in life, and (b) the increasing proportion of older adults due to the aging "Baby Boomer" population. The relative incidence of HF is lower in women compared to men, but there is a greater prevalence in women overall due to their longer life expectancy. AHF accounts for 12 to 15 million office visits per year and 6.5 million hospitalizations annually. According to national registries, patients presenting with AHF are older (mean age 75 years) and have numerous co-morbidities such as coronary artery disease (CAD), renal insufficiency, and diabetes.

Total estimated direct and indirect costs for managing both chronic and acute HF in the United States for 2008 was approximately $34.8 billion. Medications account for approximately 10% of that cost. HF is the most common hospital discharge diagnosis for Medicare patients and is the most costly diagnosis in this population.

The prognosis for patients hospitalized for AHF remains poor. Average hospital length of stay is estimated to be between 4 and 6 days, a number which has remained constant over the past decade. The in-hospital mortality rate has been estimated at approximately 4%, but ranges from 2% to 20% depending on the report.4 In-hospit-al mortality increases to an average of 10.6% in patients requiring an intensive care unit admission. Readmissions are also high, with up to 30% to 60% of patients readmitted within 6 months of their initial discharge date.4 The 5-year mortality rate for chronic HF remains approximately 50%. Survival strongly correlates with severity of symptoms and functional capacity. Sudden cardiac death is the most common cause of death, occurring in approximately 40% of patients with HF. Although therapies targeting the upregulated neurohormonal response contributing to the pathophysiology of HF have clearly impacted morbidity and mortality, long-term survival remains low.

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