Background—: Cardiovascular disease (CVD) is the leading cause of death in the United States and is responsible for 17% of national health expenditures. As the population ages, these costs are expected to increase substantially. Methods and Results—: To prepare for future cardiovascular care needs, the American Heart Association developed methodology to project future costs of care for hypertension, coronary heart disease, heart failure, stroke, and all other CVD from 2010 to 2030. This methodology avoided double counting of costs for patients with multiple cardiovascular conditions. By 2030, 40.5% of the US population is projected to have some form of CVD. Between 2010 and 2030, real (2008$) total direct medical costs of CVD are projected to triple, from $273 billion to $818 billion. Real indirect costs (due to lost productivity) for all CVD are estimated to increase from $172 billion in 2010 to $276 billion in 2030, an increase of 61%. Conclusions—: These findings indicate CVD prevalence and costs are projected to increase substantially. Effective prevention strategies are needed if we are to limit the growing burden of CVD.

Background—: Heart failure (HF) is an important contributor to both the burden and cost of national healthcare expenditures, with more older Americans hospitalized for HF than for any other medical condition. With the aging of the population, the impact of HF is expected to increase substantially. Methods and Results—: We estimated future costs of HF by adapting a methodology developed by the American Heart Association to project the epidemiology and future costs of HF from 2012 to 2030 without double counting the costs attributed to comorbid conditions. The model assumes that HF prevalence will remain constant by age, sex, and race/ethnicity and that rising costs and technological innovation will continue at the same rate. By 2030, >8 million people in the United States (1 in every 33) will have HF. Between 2012 and 2030, real (2010$) total direct medical costs of HF are projected to increase from $21 billion to $53 billion. Total costs, including indirect costs for HF, are estimated to increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be 3-fold higher ($160 billion in direct costs). Conclusions—: The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed.

Research from JAMA — Relationship Between Early Physician Follow-up and 30-Day Readmission Among Medicare Beneficiaries Hospitalized for Heart Failure

Background—: Heart failure with preserved ejection fraction (EF) is a common syndrome, but trends in treatments and outcomes are lacking. Methods and Results—: We analyzed data from 275 hospitals in Get With the Guidelines–Heart Failure from January 2005 to October 2010. Patients were stratified by EF as reduced EF (EF <40% [HF–reduced EF]), borderline EF (40%≤EF<50% [HF–borderline EF]), or preserved (EF ≥50% [HF–preserved EF]). Using multivariable models, we examined trends in therapies and outcomes. Among 110 621 patients, 50% (55 083) had HF–reduced EF, 14% (15 184) had HF–borderline EF, and 36% (40 354) had HF–preserved EF. From 2005 to 2010, the proportion of hospitalizations for HF–preserved EF increased from 33% to 39% ( P <0.0001). In multivariable analyses, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge decreased in all EF groups, and β-blocker use increased. Patients with HF–preserved EF less frequently achieved blood pressure control (adjusted odds ratio, 0.44 versus HF–reduced EF; P <0.001) and were more likely discharged to skilled nursing (adjusted odds ratio, 1.16 versus HF–reduced EF; P <0.001). In-hospital mortality for HF–preserved EF decreased from 3.32% in 2005 to 2.35% in 2010 (adjusted odds ratio, 0.89 per year; P =0.01) but was stable for patients with HF–reduced EF (3.03%–2.83%; adjusted odds ratio, 0.93 per year; P =0.10). Conclusions—: Hospitalization for HF–preserved EF is increasing relative to HF–reduced EF. Although in-hospital mortality for patients with HF–preserved EF declined over the study period, an important opportunity remains for identifying evidence-based therapies in patients with HF–preserved EF.