1. A. Heart failure: A challenge to the healthcare delivery system
Heart failure: US statistics
Content points:
Heart failure (HF) presents a tremendous challenge to the US healthcare system. Nearly 5 million Americans have HF and there are an estimated 550,000 new cases each year.1
In 2000, there were 999,000 hospital discharges for HF, compared with 377,000 in 1979, an increase of 165%.
HF accounts for approximately 52,000 deaths annually. Sudden deaths occur at 6 to 9 times the rate of the general population.
HF is a major cause of morbidity and mortality among the elderly: It is the leading hospital discharge diagnosis for Medicare patients.
The total direct and indirect annual costs for HF are estimated at $24.3 billion.
1 American Heart Association. Heart and Stroke Statistics—2003 Update. Dallas, Tex. American Heart Association

2. The comparative cost of heart failure Content points:
The costs associated with HF are higher than the costs for either cancer or myocardial infarction (MI), due to frequent hospitalizations, use of consultant physicians, outpatient tests and procedures, and long-term drug therapy.1 (The costs are based on 1991 Health Care Financing Administration expenditures and compare HF with the five leading diagnosis-related groups [DRGs] for cancer and with two DRGs for MI).
With the aging of the 75 million baby boomers, HF prevalence will increase in the coming decades and the related costs will climb dramatically.
1 O’Connell JB. The economic burden of heart failure. Clin Cardiol. 2000;23(SupplIII):III6–III10.

3. High lifetime risk of heart failure Content points:
According to estimates from the Framingham Heart Study, people free of HF at age 40 have a 1 in 5 risk of developing HF during their remaining lifetime.1 This risk is similar for men and women and it continues with advancing age. For example, at age 80, the remaining lifetime risk is 20.2% for men and 19.3% for women.
The lifetime risk for HF is doubled with blood pressure (BP) ≥160/100 mm Hg compared with BP <140/90 mm Hg.
The lifetime risk of HF occurring in the absence of MI is 1 in 9 in men and 1 in 6 in women, which highlights the risk of HF that is largely attributable to hypertension. This indicates that MI is an important HF risk factor in men and that for women other factors, notably hypertension, are more important contributors to the risk of HF.
1 Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D’Agostino RB, Kannel WB, et al. Lifetime risk for developing congestive heart failure. The Framingham Heart Study. Circulation. 2002;106: