Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012
The cumulative burden and importance of cardiovascular risk factors have changed over the past decades. Specifically, obesity rates have increased among younger people, whereas cardiovascular health has improved in the elderly. Little is known regarding how these changes have impacted the incidence...
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| Veröffentlicht in: | Circulation (New York, N.Y.) Jg. 135; H. 13; S. 1214 - 1223 |
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| Hauptverfasser: | , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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28.03.2017
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| ISSN: | 1524-4539 |
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| Abstract | The cumulative burden and importance of cardiovascular risk factors have changed over the past decades. Specifically, obesity rates have increased among younger people, whereas cardiovascular health has improved in the elderly. Little is known regarding how these changes have impacted the incidence and the mortality rates of heart failure. Therefore, we aimed to investigate the age-specific trends in the incidence and 1-year mortality rates following a first-time diagnosis of heart failure in Denmark between 1995 and 2012.
We included all Danish individuals >18 years of age with a first-time in-hospital diagnosis of heart failure. Data were collected from 3 nationwide Danish registries. Annual incidence rates of heart failure and 1-year standardized mortality rates were calculated under the assumption of a Poisson distribution.
We identified 210 430 individuals with a first-time diagnosis of heart failure between 1995 and 2012; the annual incidence rates per 10 000 person-years declined among older individuals (rates in 1995 versus 2012: 164 versus 115 in individuals >74 years, 63 versus 35 in individuals 65-74 years, and 20 versus 17 in individuals 55-64 years;
<0.0001 for all) but increased among the younger (0.4 versus 0.7 in individuals 18-34 years, 1.3 versus 2.0 in individuals 35-44 years, and 5.0 versus 6.4 in individuals 45-54 years;
<0.0001 for all). The proportion of patients with incident heart failure ≤50 years of age doubled from 3% in 1995 to 6% in 2012 (
<0.0001). Sex- and age-adjusted incidence rate ratios for 2012 versus 1996 were 0.69 (95% confidence interval, 0.67-0.71;
<0.0001) among people >50 years of age, and 1.52 (95% confidence interval, 1.33-1.73;
<0.0001) among individuals ≤50 years of age; it remained essentially unchanged on additional adjustment for diabetes mellitus, ischemic heart disease, and hypertension. Standardized 1-year mortality rates declined for middle-aged patients with heart failure but remained constant for younger (<45 years) and elderly (≥65 years) patients. The prevalence of comorbidities (including diabetes mellitus, hypertension, and atrial fibrillation) increased, especially in younger patients with heart failure.
Over the past 2 decades, the incidence of heart failure in Denmark declined among older individuals (>50 years), but increased among younger (≤50 years) individuals. These observations may portend a rising burden of heart failure in the community. |
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| AbstractList | The cumulative burden and importance of cardiovascular risk factors have changed over the past decades. Specifically, obesity rates have increased among younger people, whereas cardiovascular health has improved in the elderly. Little is known regarding how these changes have impacted the incidence and the mortality rates of heart failure. Therefore, we aimed to investigate the age-specific trends in the incidence and 1-year mortality rates following a first-time diagnosis of heart failure in Denmark between 1995 and 2012.
We included all Danish individuals >18 years of age with a first-time in-hospital diagnosis of heart failure. Data were collected from 3 nationwide Danish registries. Annual incidence rates of heart failure and 1-year standardized mortality rates were calculated under the assumption of a Poisson distribution.
We identified 210 430 individuals with a first-time diagnosis of heart failure between 1995 and 2012; the annual incidence rates per 10 000 person-years declined among older individuals (rates in 1995 versus 2012: 164 versus 115 in individuals >74 years, 63 versus 35 in individuals 65-74 years, and 20 versus 17 in individuals 55-64 years;
<0.0001 for all) but increased among the younger (0.4 versus 0.7 in individuals 18-34 years, 1.3 versus 2.0 in individuals 35-44 years, and 5.0 versus 6.4 in individuals 45-54 years;
<0.0001 for all). The proportion of patients with incident heart failure ≤50 years of age doubled from 3% in 1995 to 6% in 2012 (
<0.0001). Sex- and age-adjusted incidence rate ratios for 2012 versus 1996 were 0.69 (95% confidence interval, 0.67-0.71;
<0.0001) among people >50 years of age, and 1.52 (95% confidence interval, 1.33-1.73;
<0.0001) among individuals ≤50 years of age; it remained essentially unchanged on additional adjustment for diabetes mellitus, ischemic heart disease, and hypertension. Standardized 1-year mortality rates declined for middle-aged patients with heart failure but remained constant for younger (<45 years) and elderly (≥65 years) patients. The prevalence of comorbidities (including diabetes mellitus, hypertension, and atrial fibrillation) increased, especially in younger patients with heart failure.
Over the past 2 decades, the incidence of heart failure in Denmark declined among older individuals (>50 years), but increased among younger (≤50 years) individuals. These observations may portend a rising burden of heart failure in the community. BACKGROUNDThe cumulative burden and importance of cardiovascular risk factors have changed over the past decades. Specifically, obesity rates have increased among younger people, whereas cardiovascular health has improved in the elderly. Little is known regarding how these changes have impacted the incidence and the mortality rates of heart failure. Therefore, we aimed to investigate the age-specific trends in the incidence and 1-year mortality rates following a first-time diagnosis of heart failure in Denmark between 1995 and 2012.METHODSWe included all Danish individuals >18 years of age with a first-time in-hospital diagnosis of heart failure. Data were collected from 3 nationwide Danish registries. Annual incidence rates of heart failure and 1-year standardized mortality rates were calculated under the assumption of a Poisson distribution.RESULTSWe identified 210 430 individuals with a first-time diagnosis of heart failure between 1995 and 2012; the annual incidence rates per 10 000 person-years declined among older individuals (rates in 1995 versus 2012: 164 versus 115 in individuals >74 years, 63 versus 35 in individuals 65-74 years, and 20 versus 17 in individuals 55-64 years; P<0.0001 for all) but increased among the younger (0.4 versus 0.7 in individuals 18-34 years, 1.3 versus 2.0 in individuals 35-44 years, and 5.0 versus 6.4 in individuals 45-54 years; P<0.0001 for all). The proportion of patients with incident heart failure ≤50 years of age doubled from 3% in 1995 to 6% in 2012 (P<0.0001). Sex- and age-adjusted incidence rate ratios for 2012 versus 1996 were 0.69 (95% confidence interval, 0.67-0.71; P<0.0001) among people >50 years of age, and 1.52 (95% confidence interval, 1.33-1.73; P<0.0001) among individuals ≤50 years of age; it remained essentially unchanged on additional adjustment for diabetes mellitus, ischemic heart disease, and hypertension. Standardized 1-year mortality rates declined for middle-aged patients with heart failure but remained constant for younger (<45 years) and elderly (≥65 years) patients. The prevalence of comorbidities (including diabetes mellitus, hypertension, and atrial fibrillation) increased, especially in younger patients with heart failure.CONCLUSIONSOver the past 2 decades, the incidence of heart failure in Denmark declined among older individuals (>50 years), but increased among younger (≤50 years) individuals. These observations may portend a rising burden of heart failure in the community. |
| Author | Andersson, Charlotte Smith, J Gustav Gislason, Gunnar H Vasan, Ramachandran S Jeppesen, Jørgen L Christiansen, Mia N Køber, Lars Torp-Pedersen, Christian Weeke, Peter |
| Author_xml | – sequence: 1 givenname: Mia N surname: Christiansen fullname: Christiansen, Mia N email: mia_nielsen7@hotmail.com, mia.nielsen.christiansen.01@regionh.dk organization: From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre Hospital, University of Copenhagen, Denmark (J.L.J., C.A.); Department of Cardiology, Lund University and Skåne University Hospital, Sweden (J.G.S.); The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.); and Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Denmark (C.T.-P.). mia_nielsen7@hotmail.com mia.nielsen.christiansen.01@regionh.dk – sequence: 2 givenname: Lars surname: Køber fullname: Køber, Lars organization: From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre Hospital, University of Copenhagen, Denmark (J.L.J., C.A.); Department of Cardiology, Lund University and Skåne University Hospital, Sweden (J.G.S.); The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.); and Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Denmark (C.T.-P.) – sequence: 3 givenname: Peter surname: Weeke fullname: Weeke, Peter organization: From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre Hospital, University of Copenhagen, Denmark (J.L.J., C.A.); Department of Cardiology, Lund University and Skåne University Hospital, Sweden (J.G.S.); The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.); and Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Denmark (C.T.-P.) – sequence: 4 givenname: Ramachandran S surname: Vasan fullname: Vasan, Ramachandran S organization: From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre Hospital, University of Copenhagen, Denmark (J.L.J., C.A.); Department of Cardiology, Lund University and Skåne University Hospital, Sweden (J.G.S.); The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.); and Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Denmark (C.T.-P.) – sequence: 5 givenname: Jørgen L surname: Jeppesen fullname: Jeppesen, Jørgen L organization: From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre Hospital, University of Copenhagen, Denmark (J.L.J., C.A.); Department of Cardiology, Lund University and Skåne University Hospital, Sweden (J.G.S.); The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.); and Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Denmark (C.T.-P.) – sequence: 6 givenname: J Gustav surname: Smith fullname: Smith, J Gustav organization: From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre Hospital, University of Copenhagen, Denmark (J.L.J., C.A.); Department of Cardiology, Lund University and Skåne University Hospital, Sweden (J.G.S.); The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.); and Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Denmark (C.T.-P.) – sequence: 7 givenname: Gunnar H surname: Gislason fullname: Gislason, Gunnar H organization: From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre Hospital, University of Copenhagen, Denmark (J.L.J., C.A.); Department of Cardiology, Lund University and Skåne University Hospital, Sweden (J.G.S.); The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.); and Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Denmark (C.T.-P.) – sequence: 8 givenname: Christian surname: Torp-Pedersen fullname: Torp-Pedersen, Christian organization: From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre Hospital, University of Copenhagen, Denmark (J.L.J., C.A.); Department of Cardiology, Lund University and Skåne University Hospital, Sweden (J.G.S.); The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.); and Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Denmark (C.T.-P.) – sequence: 9 givenname: Charlotte surname: Andersson fullname: Andersson, Charlotte organization: From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre Hospital, University of Copenhagen, Denmark (J.L.J., C.A.); Department of Cardiology, Lund University and Skåne University Hospital, Sweden (J.G.S.); The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.); and Department of Clinical Epidemiology, Aalborg University Hospital and Department of Health, Science and Technology, Aalborg University, Denmark (C.T.-P.) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28174193$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | 2017 American Heart Association, Inc. |
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| DOI | 10.1161/CIRCULATIONAHA.116.025941 |
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| Keywords | mortality heart failure age-specific trends incidence |
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| SubjectTerms | Adolescent Adult Comorbidity Denmark - epidemiology Female Heart Failure - epidemiology History, 20th Century History, 21st Century Humans Incidence Male Middle Aged Mortality Risk Factors Young Adult |
| Title | Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012 |
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