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Brief Report
September 2, 2020

Trends in the Prevalence of Self-reported Heart Failure by Race/Ethnicity and Age From 2001 to 2016

Author Affiliations
  • 1Division of Cardiology, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 3Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 4Deputy Editor, JAMA Cardiology
JAMA Cardiol. Published online September 2, 2020. doi:10.1001/jamacardio.2020.3654
Key Points

Question  Given changing cardiovascular risk factor profiles, were there differences in the prevalence of ambulatory heart failure by race/ethnicity and age in the US from 2001 through 2016?

Findings  In this cross-sectional study of 26 097 participants from the National Health and Nutrition Examination Survey, the prevalence of ambulatory heart failure was stable between 2001 and 2016. Heart failure prevalence was higher in Black participants compared with White participants, with the greatest disparities among adults aged 35 to 64 years.

Meaning  This study found that the prevalence of heart failure remained unchanged between 2001 and 2016, and large racial disparities persisted particularly by age group.

Abstract

Importance  Despite recent advances in therapies for heart failure (HF), deaths from HF are increasing, with persistent disparities between Black and White adults. Recent national trends in the prevalence of HF need to be clarified to appropriately allocate resources and develop effective preventive interventions.

Objectives  To examine the prevalence of ambulatory HF overall and by race/ethnicity and age and the temporal changes in HF prevalence between 2001 and 2016.

Design, Setting, and Participants  This cross-sectional study of nationally representative data collected biennially through the National Health and Nutrition Examination Survey (NHANES) from January 1, 2001, to December 31, 2016, assessed nonpregnant adults 35 years and older who self-identified as non-Hispanic Black, non-Hispanic White, or Mexican American. Data analysis was performed from November 16, 2019, to April 12, 2020.

Exposures  Survey period, race/ethnicity, and age group.

Main Outcomes and Measures  Age-standardized prevalence was calculated within 4-year survey periods (2001-2004, 2005-2008, 2009-2012, and 2013-2016) based on self-report of ambulatory HF overall and by race/ethnicity and age group (35-64 and ≥65 years). Weighted multivariable logistic regression was used to examine trends in ambulatory HF prevalence over time by race/ethnicity and age group.

Results  A total of 26 097 participants (mean [SD] age, 55.9 [10.7] years; 13 192 [52%] female; 6519 [12%] non-Hispanic Black; and 4906 [7%] Mexican American) were studied. Overall age-standardized prevalence (per 100 000 population) of ambulatory HF was 3184 (95% CI, 2641-3728) from 2001 to 2005 and 3045 (95% CI, 2651-3438) from 2013 to 2016. The prevalence of ambulatory HF was highest among non-Hispanic Black adults: from 2013 to 2016, HF prevalence (per 100 000 population) was 5017 (95% CI, 3755-6279) among non-Hispanic Black adults, 2746 (95% CI, 2313-3179) among non-Hispanic White adults, and 2508 (95% CI, 1154-3862) among Mexican American adults. Differences between White and Black adults in HF prevalence were also present in younger and middle-aged adults (eg, 35-64 years of age in 2013-2016: 3864 [95% CI, 2369-5359] for non-Hispanic Black adults vs 1297 [95% CI, 878-1716] for non-Hispanic White adults).

Conclusions and Relevance  This study found that a high burden of ambulatory HF persisted between 2001 and 2016 in the US. Disparities were most prominent by age group. Alongside prevention and aggressive management of risk factors, targeted efforts aimed at mitigating racial disparities are needed.

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