Heart Disease and the Oldest Old

This is an interesting article from the Archives of Internal Medicine on heart disease and elderly people. They suggest the results are surprising as heart disease is a disease of age and when we get older it should increase in incidence. What they find is that while heart disease does increases in individuals from 65-69 it drops dramatically when in an age cohort that includes individuals 85 and older (~10 %). I actually don't find these results all that astonishing as there appears to be an important shift in what the medical community uses as traditional risk factors for heart disease as individual transitions from middle age into being elderly (whatever that means). This would appear to be mirrored in these data as well.

I enjoy articles like this because they make us confront a whole host of issues that are going to become important over the next two decades. As I've mentioned before the fastest growing non-immigrant segment of US is those 85 and older (referred to as the oldest old). The problem is we really don't understand the underlying physiology of this transition and its implications for social policy and public health.

Incidence and Prevalence of Heart Failure in Elderly Persons, 1994-2003

Lesley H. Curtis, PhD; David J. Whellan, MD, MHS; Bradley G. Hammill, MS; Adrian F. Hernandez, MD, MHS; Kevin J. Anstrom, PhD; Alisa M. Shea, MPH; Kevin A. Schulman, MD

Background Recent analyses have presented conflicting evidence regarding the incidence and prevalence of heart failure in the United States. We sought to estimate the annual incidence and prevalence of heart failure and associated survival in elderly persons from January 1, 1994, through December 31, 2003.

Methods We conducted a retrospective cohort study of 622 789 Medicare beneficiaries 65 years or older who were diagnosed as having heart failure between 1994 and 2003. The main outcome measures were incidence and prevalence of heart failure and survival following a heart failure diagnosis.

Results The incidence of heart failure declined from 32 per 1000 person-years in 1994 to 29 per 1000 person-years in 2003 (P < .01). Incidence declined most sharply among beneficiaries aged 80 to 84 years (from 57.5 to 48.4 per 1000 person-years, P < .01) and increased slightly among beneficiaries aged 65 to 69 years (from 17.5 to 19.3 per 1000 person-years, P < .01). Although risk-adjusted mortality declined slightly from 1994 to 2003, the prognosis for patients diagnosed as having heart failure remains poor. In 2002, risk-adjusted 1-year mortality was 27.5%, more than 3 times higher than for age- and sex-matched patients.

Conclusions Although the incidence of heart failure has declined somewhat during the past decade, modest survival gains have resulted in an increase in the number of patients living with heart failure. Identifying optimal strategies for the treatment and management of heart failure will become increasingly important as the size of the Medicare population grows.