22 November 2017
The number of people being diagnosed with heart failure in the UK continues to grow, and the poorest people are significantly more likely to be affected by the condition, new research from The George Institute for Global Health at the University of Oxford has found.
The study, published in The Lancet, shows that not only are people in the most deprived socio-economic groups about 60% more likely to be affected by heart failure, but that the gap between the richest and the poorest didn’t close at all between 2002 and 2014.
People in the poorest neighbourhoods are likely to be affected by heart failure about 3.5 years earlier in life than those in the wealthiest areas (at an average age of 74.5, compared with 78). Disparities between different socio-economic groups actually grew during the study period, with the age at which heart failure is diagnosed rising for the most affluent, but dropping slightly among the most deprived.
The research, led by Nathalie Conrad and Professor Kazem Rahimi, analysed data on four million people to investigate trends and patterns in heart failure incidence across the UK.
Their findings show significant regional variations, with the highest incidence rates for heart failure in 2014 seen in the East Midlands (410-449 cases per 100,000 people); the North-West (370-409 cases per 100,000 people); and the North-East, Yorkshire and the Humber, and the West Midlands (all with 330-369 cases per 100,000 people). The lowest incidence rates were seen in the South East Coast region (250-289 cases per 100,000 people).
“These regional and socio-economic disparities in the incidence of heart failure and age at onset within the same country highlight the preventable nature of the disease, and suggest we still have a lot of work to do to tackle it,” said Conrad.
“If we could achieve the incidence rates we see among the most affluent groups for the population as a whole, we would observe a fall of about one-fifth or nearly 32,000 fewer cases every year.”
Further research is needed to understand what is behind the varying rates of heart failure in different communities. The discrepancies may be linked to the presence of other illnesses; to risk factors such as blood pressure, smoking and diet; or to a less effective use of drugs that can help prevent heart failure.
The study showed that heart failure affected nearly a million people in the UK in 2014; a rise of 23% from 2002. Despite modest improvements in prevention and an increase in the age at which patients develop the disease, there are now as many new cases of heart failure each year as there are of the four most common cancers combined (lung, breast, bowel and prostate).
The rise in the incidence of heart failure is largely due to an increase in the number of older people in the UK; the number of people aged 65-69 rose by 36% between 2002 and 2014, with the post-war ‘baby boomer’ generation reaching an age at which they are at greater risk of heart failure.
The study also found a substantial increase in the number of other illnesses experienced by those with heart failure; the proportion of patients suffering three or more additional conditions rose from 68% to 87% during the study period.
“The number of diseases associated with heart failure was high, and increased over time,” said Professor Rahimi, deputy director of The George Institute for Global Health UK. “This suggests that as the number of patients with heart failure grows, caring for them is also becoming more complex, increasing the burden on health services.”
Professor Jeremy Pearson, associate medical director at the British Heart Foundation, which funded the study, said: “Heart failure is a cruel and debilitating illness affecting nearly a million people across the UK, with sufferers in severe cases often having poorer survival rates than many cancers.
“Currently, heart failure is incurable and difficult to treat, and the number of people living with it is increasing. This study highlights the urgent need for more to be done to end the postcode lottery in heart failure incidence.”
Comment by Dr Faiez Zannad, Université de Lorraine, France, please see: http://www.thelancet-press.com/embargo/UKheart.pdf
Access to the appendix, please see: www.thelancet-press.com/embargo/UKheartAPPX.pdf
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University of Oxford
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About Nathalie Conrad
Nathalie Conrad is a PhD student at The George Institute for Global Health at the University of Oxford. Her research focusses on the epidemiology of cardiovascular diseases using large real-world data sets, and is supported by a British Heart Foundation scholarship. Nathalie has expertise in healthcare informatics and digital health systems, and holds an engineering master’s degree from the Swiss Federal Institute of Technology (ETH) Zurich.
About Professor Kazem Rahimi (@kazemr)
Kazem Rahimi is an Associate Professor of Cardiovascular Medicine at the University of Oxford. He is a cardiologist, epidemiologist and health services researcher with an interest in the prevention and management of chronic diseases. He is the Director of the Oxford Martin programme on Deep Medicine, which is using some of the largest and most complex biomedical datasets that have ever been collected to generate insights into complex disease patterns, risk trajectories and treatment effects. As the Deputy Director of The George Institute UK, he leads a team of researchers that are working towards the identification of practical and affordable solutions that address the unmet healthcare needs of vulnerable or disadvantaged populations globally.
The George Institute for Global Health
The George Institute for Global Health conducts clinical, population and health system research aimed at changing health practice and policy worldwide. The Institute has a global network of medical and health experts working together to address the leading causes of death and disability. Established in Australia and affiliated with UNSW Sydney, the Institute today also has offices in China, India and the United Kingdom. The George Institute UK was established in 2010 in partnership with the University of Oxford.
Twitter @GeorgeInstUK Web georgeinstitute.org.uk