Introduction: Heart failure (HF) is a common and a serious condition that predominantly affects elderly people. On the basis of the left ventricular ejection fraction (EF) it can be divided into HF with reduced or preserved ejection fraction (HFrEF and HFpEF, respectively). The goal of this study was to investigate the prevalence and incidence of HF among elderly Icelanders, explore underlying diseases and estimate the effect of HF on overall survival.

Material and methods: Included were 5706 participants of the AGES study. The hospital records of those diagnosed with HF before entry into AGES were used to calculate prevalence and the records of those diagnosed from entry into AGES until 28.2.2010 were used to calculate incidence. All cases of HF were verified according to predetermined criteria for diagnosis. Information on underlying diseases and EF of HF patients were obtained from hospital records. Survival was estimated using Kaplan-Meier survival curves.

Results: Lifetime prevalence of HF was 3.6% as of 2004, higher among men than women (p<0,001). The incidence was 16.2 cases per 1000 person-years, higher among men than among women (p<0,001). The incidence of HFrEF was 6.1 per 1000 person-years also higher among men than women (p<0,001). The incidence of HFpEF was 6.8 per 1000 person-years and there was no statistical difference between the sexes (p=0.62). The age adjusted 5-year survival rate of HF-patients was 32.5%, there was no statistical difference in relative survival between men and women (p=0.46). There was no statistical difference between the survival of patients with HFrEF and those with HFpEF (p=0.52).

Conclusion: Both prevalence and incidence of HF are high among elderly Icelanders, increasing sharply with age and 5-year survival rate is only around 30%. While men are more likely to develop HF, especially HFrEF, women are more likely to be diagnosed with HFpEF.

Figure I: AGES criteria for diagnosis of heart failure.

Figure II: The prevalence of heart failure per age groups and gender, including a 95% confidence interval.

Figure III: The incidence of heart failure per age groups and gender, including a 95% confidence interval.

Figure IV: The incidence of HFrEF per age groups and gender, including a 95% confidence interval.

Figure V: The incidence of HFpEF per age groups and gender, including a 95% confidence interval.

Figure VI: Kaplan-Meier estimates of age adjusted long-term survival of patients with heart failure.

Figure VII: Life expectancy by age of males who were diagnosed with heart failure compared to those with no history of heart failure.

Figure VIII: Life expectancy by age of females who were diagnosed with heart failure compared to those with no history of heart failure.

Table I: Cases of heart failure by gender and HF type.

Table II: Common underlying diseases of heart failure by HF type.