Prevalence of Heart Failure Has Remained Stable Over the Last 2 Decades in the United States

20s male patient in hospital bed listening to doctor and nurse in hospital
A study was conducted to evaluate heart failure prevalence trends in the general adult US population during the past 2 decades.

Over the last 2 decades, the prevalence of heart failure (HF) has remained stable while the prevalence of obesity and diabetes has been increasing in the United States (US), according to results of a study published in the International Journal of Cardiology.

Investigators at the University of Milano Bicocca in Italy sourced data for this study from the 1999 to 2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Trends in HF and related conditions were evaluated over 20 years among individuals (N=34,403) aged 40 years or older who attended a mobile examination visit.

In each 4-year survey cycle, the prevalence of HF increased with age and was more frequently observed among individuals with comorbid obesity or diabetes and those who were former smokers. The rate of HF remained stable at 3.5% in 1999 to 2002 and 3.6% in 2015 to 2018.

Unlike HF, obesity increased from 39.2% in 1999 to 2002 to 64.2% in 2015 to 2018 (P <.001) and diabetes rates increased from 30.9% to 45.8% during the same cycles (P <.001), respectively.

Over time, control of low-density lipoprotein cholesterol (defined as <100 mg/dl) became more prevalent, with fewer than a third of patients maintaining low cholesterol levels in 1999 to 2002 (27.9%) to over half in 2015 to 2018 (59.6%; P <.001).

Better cholesterol control was likely related with the increase in medication use, in which the proportion of individuals taking statins nearly doubled between 1999 and 2002 (34.8%) and 2007 to 2010 (58.1%; P <.001), remaining stable thereafter. For other medications, there were significant increases in use of angiotensin receptor blockers, beta blockers, and any glucose-lowering medications. Use of angiotensin converting enzyme inhibitors and calcium channel blockers or loop diuretics remained relatively stable over time.

The major limitation of this study was the reliance on self-reported and not diagnosed HF.

“…while the prevalence of HF in US adults remained stable in the last 20 years, prevalence of both obesity and diabetes (and use of glucose-lowering therapies) increased significantly and they affect half of patients with HF,” the study authors noted. “Though improvement has been made in the control of dyslipidemia and, to a lesser extent, blood pressure, significant gaps remain in guideline-directed use of HF and diabetes medications. “


Ciardullo S, Cannistraci R, Mazzetti S, Mortara A, Perseghin G. Twenty-year trends in heart failure among U.S. adults, 1999–2018: The growing impact of obesity and diabetes. Int J Cardiol. Published online April 26, 2022. doi:10.1016/j.ijcard.2022.02.037