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Congestive Heart Failure:
National Heart, Lung, and Blood Institute Data Fact Sheet
Congestive Heart Failure in the United States: A New
An estimated 4.8 million Americans have congestive heart
failure (CHF). Increasing prevalence, hospitalizations, and
deaths have made CHF a major chronic condition in the United
States. It often is the end stage of cardiac disease. Half
of the patients diagnosed with CHF will be dead within 5
years. Each year, there are an estimated 400,000 new cases.
The annual number of deaths directly from CHF increased from
10,000 in 1968 to 42,000 in 1993 (figure 1), with another
219,000 related to the condition.
CHF is the first-listed diagnosis in 875,000
hospitalizations, and the most common diagnosis in hospital
patients age 65 years and older. In that age group, one-
fifth of all hospitalizations have a primary or secondary
diagnosis of heart failure.
Visits to physicians' offices for CHF increased from 1.7
million in 1980 to 2.9 million in 1993. More than 65,000
persons with CHF receive home care each year. In 1993, an
estimated $17.8 billion was spent for the care of CHF
patients in hospitals, physicians' offices, home care, and
nursing homes as well as for medication. The financial and
other losses of caregivers for these patients are large as
The magnitude of the problem of CHF is large now, but it is
expected to get much worse because:
- As more and more cardiac patients are able to survive and
live longer with their disease, their opportunity for
developing CHF increases.
- Future growth in the elderly population will likely result
in increasing numbers of persons with this condition
regardless of trends in coronary disease morbidity and
Incidence data on congestive heart failure are not available
on a national basis. The following estimates are from the
study in Framingham, Massachusetts, funded by the National
Heart, Lung, and Blood Institute. Incidence of CHF is
equally frequent in men and women, and annual incidence
approaches 10 per 1,000 population after 65 years of age.
Incidence is twice as common in persons with hypertension
compared with normotensive persons and five times
greater in persons who have had a heart attack compared to
persons who have not.
Incidence of CHF in Men and Women Age 50 to 79, by
Note: Hypertension is defined as systolic blood pressure
(SBP) of 140 mm Hg or greater or diastolic blood pressure
(DBP) of 90 mm Hg or greater or taking antihypertensive
medication. Stage 1 hypertension is defined as SBP of 140
to 159 mm Hg or DBP of 90 to 99 mm Hg in people not
receiving antihypertensive medication; stage 2 or greater
hypertension (stage 2+) is defined as SBP of 160 or greater,
DBP of 100 or greater, or current use of antihypertensive
According to the National Health and Nutrition Examination
Surveys, an estimated 4.8 million Americans have congestive
heart failure, with approximately equal numbers of men and
women. Almost 1.4 million are under 60 years of age. CHF
is present in 2 percent of persons age 40 to 59, more than 5
percent of persons age 60 to 69, and 10 percent of persons
age 70 and older. Prevalence is at least 25
percent greater among the black population than among the
white population. Prevalence at each age increased
substantially between two periods surveyed nationally:
1976-80 and 1988-91.
The rate of hospitalizations for heart failure increased
more than three times between 1970 and 1994 at age 45 to 64
and age 65 and older, with a large absolute increase in the
older age group. In 1994, CHF was the first-
listed discharge diagnosis in 874,000 hospital discharges
(alive or dead) and a secondary diagnosis in another 1.8
million discharges. One in five of all discharged patients
age 65 and older had CHF as a primary or secondary
diagnosis. The percentage of CHF patients discharged dead
from hospitals, however, decreased from 11.3 percent in 1981
to 6.1 percent in 1993. This trend is seen for persons age
45 to 64 and for those age 65 and older.
Survival following diagnosis of congestive heart failure is
worse in men than women, but even in women, only about 20
percent survive much longer than 8 to 12 years. The outlook
is not much better than for most forms of cancer. The
fatality rate for CHF is high, with one in five persons
dying within 1 year. Sudden death is common in these
patients, occurring at a rate of six to nine times that of
the general population. Thus, CHF remains a highly lethal
condition. With the use of angiotensin-converting enzyme
(ACE) inhibitors as a possible exception, advances in the
treatment of hypertension, myocardial ischemia, and valvular
heart disease have not resulted in substantial improvements
in survival once CHF ensues.
The death rate for congestive heart failure increased most
years between 1968 and 1993. These increases are
in contrast to mortality declines for most heart and blood
vessel diseases. In 1993, there were 42,000 deaths where
CHF was identified as the primary cause of death and another
219,000 deaths where it was listed as a secondary cause on
the death certificate. The death rate for CHF in 1993 was
nearly 1.5 times higher in black men and women than in white
men and women.
The National Heart, Lung, and Blood Institute (NHLBI)
supports a wide range of basic, clinical, and
epidemiological research to better understand the causes and
improve the prevention, diagnosis, and treatment of CHF.
The studies include investigations of how the heart
contracts normally and what goes wrong in CHF, the
development of new drug therapies and other innovative
treatments of CHF, and ways to better detect the condition
in those at a high risk of CHF.
Some studies are trying to stop the loss of cell function
that happens in CHF. Muscle cells die or no longer function
properly, which causes the heart to lose its ability to pump
blood. In studies on animals, researchers have begun
inserting healthy muscle cells into a failing heart to
replace damaged cells. Results so far have been promising:
The grafted cells appear to thrive and function normally.
This animal research has shown that the grafted cells can
even come from muscles other than the heart, such as muscles
of the leg. Furthermore, it may be possible to genetically
engineer grafted cells to make them stronger.
Other studies are developing drugs with multiple actions to
treat CHF. Such a drug would have several effects. For
example, a drug might improve the heart's pumping ability,
open clogged arteries, and prevent tissue damage from free
radicals, a byproduct of the body's metabolic processes.
Free radicals are thought to contribute to the development
of atherosclerosis. One of these multiple-acting drugs has
already been tested and appears not only to lengthen
survival but also to improve symptoms for those with CHF.
Investigations also are being done to improve heart
transplantation for CHF patients. In some cases, a heart
transplant is the only possible treatment. However, such
patients face a shortage of donor hearts. A possible
solution to this critical shortage may be the use of a heart
from other animals. Called xenotransplantation, this
procedure once was made difficult because of the rejection
of the heart by the CHF patient's immune system. However,
new technologies have been forged that can overcome such a
barrier. For example, scientists have been able to alter
genes in the heart of a pig to diminish the immune system
reaction in a baboon. Scientists still need to discover how
to turn such genes on and off to prevent human rejection.
Researchers are continuing efforts to develop better devices
to help the damaged heart function. Already in use is a
small mechanical pump called a left ventricular assist
device (LVAD). The ventricles are the heart's main pumping
chambers. These chambers enlarge as CHF progresses. Muscle
fibers stretch, and the heart loses strength. The LVAD is
now used as a temporary assist for patients with severe CHF
who are awaiting a heart transplant. However, researchers
have found that the heart in patients with an LVAD often
improves after months of use--so much that a transplant
is no longer needed. Thus, efforts are underway to
identify patients who may benefit from a longer-term LVAD.
Through its national education efforts, the NHLBI is working
to prevent CHF too, especially through the early detection
and aggressive treatment of high blood pressure and heart
attack--the two leading causes of CHF. New drug therapies,
better diagnosis, and speedier therapies are lessening those
conditions' impact on the heart.
For more information, contact:
NHLBI Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
National Heart, Lung, and Blood Institute
Information provided by the NIH.