Temporal trends of heart failure epidemic in the Rotterdam Study over three decades

Aim There is limited information on the heart failure (HF) epidemic and its temporal changes. Current research aimed to report the HF epidemic over the past three decades in the Rotterdam Study, covering the prevalence and incidence of HF, comorbidities and risk determinants. Methods Using data from the population-based Rotterdam cohort, three Epoch groups [Epoch 1990s (1989-1993, N=7,983), Epoch 2000s (1997-2001, N=7,738), and Epoch 2010s (2009-2014, N=6,170)] were identified, with a mean age of nearly 70 years. For each Epoch group, point prevalence at baseline and 5-year HF incidence rate, comorbidities at baseline, and HF risk determinants (using Cox proportional hazards models) were calculated. Results Point prevalence of HF was 3.3% in Epoch 1990s, 6.0% in Epoch 2000s, and 4.8% in Epoch 2010s, with an increase from the 1990s to 2000s followed by a decline in the 2010s, yielding an overall statistically significant upward trend (p<0.001). 5-year incidence of HF per 1,000 person-years was 16.3 (95%CI: 15.0 to 17.8), 10.3 (95%CI: 9.2 to 11.4) and 7.9 (95%CI: 6.9 to 9.0) in respective epochs, with a downward trend. Hypertension was the most common comorbidity in HF patients, followed by dyslipidemia and kidney dysfunction. The association of hypertension and diabetes with risk of incident HF decreased over time. Coronary heart disease (CHD), atrial fibrillation (AF) and stroke all showed increasing hazard ratios across groups. Conclusions The prevalence of HF increased during the past decades in a population-based setting, while HF incidence declined. Hypertension and diabetes tended to become less critical risk factors for new-onset HF nowadays, while CHD, AF, and stroke showed trends toward stronger associations with HF risk over time.