Heart failure and cardiomyopathy

What is heart failure and cardiomyopathy?

Heart failure occurs when the heart begins to function less effectively in pumping blood around the body. It can occur suddenly, although it usually develops slowly as the heart gradually becomes weaker.

Heart failure can result from a variety of diseases and conditions that impair or overload the heart. These include heart attack, high blood pressure, damaged heart valves or cardiomyopathy.

Cardiomyopathy is where the entire heart muscle, or a large part of it, is weakened. Causes of weakening include coronary heart disease, hypertension, viral infections and alcohol consumption above guideline levels. Cardiomyopathy and heart failure commonly occur together.

People with mild heart failure may have few symptoms, but in more severe cases it can result in chronic tiredness, reduced capacity for physical activity and shortness of breath. It often occurs as a comorbid condition with other chronic diseases, including CHD, diabetes and chronic kidney disease.

Generally, heart failure cannot be cured because the heart muscle has been irreversibly damaged, although some forms, caused by particular impairments such as heart valve defects or certain effects of a heart attack, may be cured if treated early enough. Treatment may improve quality of life, reduce hospital admissions and extend a person’s life. In certain end-stage patients, heart transplantation may be used.

How many Australians have heart failure?

Prevalence

An estimated 102,000 people aged 18 and over (0.5%) had heart failure in 2017–18, based on self-reported data from the ABS 2017–18 National Health Survey (ABS 2018).

Two-thirds of adults with heart failure (68,500 people) were aged 65 and over.

However, using self-reported data to estimate the number of people with heart failure underestimates the true burden, as the early stages of the disease are only mildly symptomatic, and a substantial proportion of cases are undiagnosed. A recent review of studies reported the prevalence of heart failure in the Australian population as ranging between 1.0% and 2.0% (Sahle et al. 2016).

Since heart failure and cardiomyopathy have a considerable impact on the health of Australians, estimates of prevalence based on self-report should be interpreted with caution.

Age and sex

An estimated 70,700 men and 40,200 women aged 18 and over had heart failure in 2017–18, based on self-reported data from the 2017–18 NHS (ABS 2018).

This corresponds to rates of 0.5% for men and 0.4% for women.

Hospitalisations

Heart failure and cardiomyopathy often occur alongside other chronic diseases, so both the principal and additional diagnoses of heart failure or cardiomyopathy should be counted when estimating their contribution to hospitalisations. As heart failure has historically been under recorded in hospital data and the accuracy of coding heart failure varies between Australian hospitals, it is likely that estimates are undercounts (Coory & Cornes 2005, Powell et al. 2000, Teng et al. 2008).

There were around 181,200 hospitalisations where heart failure or cardiomyopathy was recorded as the principal and/or additional diagnosis in 2018–19. This represents 1.6% of all hospitalisations in Australia in 2018–19.

Heart failure or cardiomyopathy was recorded as the principal diagnosis in 40% (73,000) of these hospitalisations.

In those cases where heart failure or cardiomyopathy was listed as an additional diagnosis, more than half (55%) had either a cardiovascular or respiratory disease listed as the principal diagnosis. The most common principal diagnoses in these cases were CHD (9.7% of hospitalisations), chronic lower respiratory diseases including bronchitis and chronic pulmonary obstructive disease (8.8%), influenza or pneumonia (9.4%) and atrial fibrillation or flutter (5.6%).

Age and sex

Where heart failure or cardiomyopathy was recorded as the principal and/or additional diagnosis, hospitalisation rates:

  • were overall 1.4 times as high for males as females (age-standardised rates of 689 and 485 per 100,000 population). Age-specific rates were higher among males than females in all age groups
  • increased with age, with rates highest for males and females aged 85 and over (13,600 and 10,700 per 100,000 population)―at least 2.5 times as high as those aged 75–84 (5,500 and 4,000 per 100,000) (Figure 1).

Figure 1: Heart failure and cardiomyopathy hospitalisation rates, principal and/or additional diagnosis, by age and sex, 2018–19

The bar chart shows that heart failure and cardiomyopathy hospitalisation rates in 2018–19 were highest among men and women aged 85 and over (13,600 and 10,700 per 100,000 population, respectively).

Trends

Between 2000–01 and 2018–19, there was a 25% reduction in the age-standardised rate of hospitalisations with a principal and/or additional diagnosis of heart failure or cardiomyopathy (767 to 579 per 100,000 population).

The number of heart failure and cardiomyopathy hospitalisations increased by 33% for males and 17% for females, while age-standardised rates fell by 25% for both males (from 922 to 689 per 100,000 population) and females (from 646 to 485) (Figure 2).

Figure 2: Heart failure and cardiomyopathy hospitalisation rates, principal and/or additional diagnosis, by sex, 2000–01 to 2018–19

The line chart shows the decline in age-standardised heart failure and cardiomyopathy hospitalisation rates between 2000–01 and 2009–10 from 922 to 684 per 100,000 population for males and 646 to 458 per 100,000 population for females. Rates remained steady between 2010–11 and 2018–19 for both males and females.

Variation among population groups

Aboriginal and Torres Strait Islander people

In 2018–19, there were around 6,200 hospitalisations with a principal and/or additional diagnosis of heart failure or cardiomyopathy among Aboriginal and Torres Strait Islander people.

After adjusting for differences in the age structure of the populations:

  •  the rate among Indigenous Australians was 2.6 times as high as the non-Indigenous rate (1,452 and 556 per 100,000 population)
  • the disparity between Indigenous and non-Indigenous Australians was greater for females than males—3.1 times as high for females (1,442 and 462 per 100,000 population) and 2.2 times as high for males (1,467 and 666 per 100,000 population) (Figure 3).

Socioeconomic group

In 2018–19, age-standardised heart failure and cardiomyopathy hospitalisation rates were almost 70% higher for people living in the lowest socioeconomic areas compared with those in the highest socioeconomic areas—734 and 435 per 100,000 population.

The gap in hospitalisation rates between the lowest and highest socioeconomic areas was similar for both males and females—1.7 times as high—for males 866 and 520 per 100,000 population, and for females 619 and 365 per 100,000 population (Figure 3).

Remoteness area

In 2018–19, the age-standardised heart failure and cardiomyopathy hospitalisation rate in Remote and very remote areas was around 60% higher compared with Major cities (885 and 555 hospitalisations per 100,000 population).

There were greater disparities in female rates (1.9 times as high—867 and 465 per 100,000 population) than males rates (1.4 times times as high—902 and 662 per 100,000 population) (Figure 3).

Figure 3: Heart failure and cardiomyopathy hospitalisation rates, principal and/or additional diagnosis, by population group and sex, 2018–19

The horizontal bar chart shows that heart failure and cardiomyopathy hospitalisation rates were higher among Indigenous Australians, people living in the lowest socioeconomic areas and people living in Remote and very remote areas.

Deaths

Heart failure and cardiomyopathy contributed to 24,000 deaths (14% of all deaths) in 2019.

Heart failure or cardiomyopathy was the underlying cause of 4,500 deaths in 2019, and was an associated cause in a further 19,500 deaths.

Heart failure and cardiomyopathy are more likely to be listed as an associated cause of death. This is because it is often not heart failure or cardiomyopathy that leads directly to death—rather, one of their complications or comorbidities will be listed as the underlying cause of death on the death certificate.

When heart failure or cardiomyopathy are examined as an associated cause of death, the conditions most commonly listed as the underlying cause of death were:

  • chronic ischaemic heart disease (17%)
  • other chronic obstructive pulmonary disease (8.0%)
  • acute myocardial infarction (6.2%)
  • atrial fibrillation and flutter (4.7%)
  • non-rheumatic aortic valve disorders (3.4%).

Age and sex

In 2019, death rates for heart failure and cardiomyopathy as the underlying or associated cause:

  • were 1.4 times as high for males as for females (age-standardised rates of 83 and 61 per 100,000 population). Age-specific rates were higher for males than females across all age groups
  • increased with age, with over 80% of deaths occurring among those aged 75 and over. Death rates for males and females were highest in the 85 and over age group (3,000 and 2,600 per 100,000 population)—5.0 times as high for males and 6.7 times as high for females aged 75–84 (598 and 389 per 100,000 population) (Figure 4).

Figure 4: Heart failure and cardiomyopathy death rates, underlying or associated cause, by age and sex, 2019

The bar chart shows that heart failure and cardiomyopathy death rates in 2019 were highest among males and females 85 years and over (3,000 and 2,600 per 100,000 population, respectively).

Trends

Between 1997 and 2019:

  • the number of deaths where heart failure or cardiomyopathy was an underlying or associated cause increased by 15%, from 20,800 to 24,000
  • age-standardised heart failure and cardiomyopathy death rates declined by more than 40%—falling from 152 to 83 per 100,000 population for males, and from 106 to 61 per 100,000 population for females (Figure 5).

Figure 5: Heart failure and cardiomyopathy death rates, underlying or associated cause, by sex, 1997–2019

The line chart shows the decline in age-standardised heart failure and cardiomyopathy death rates between 1997 and 2019 from 152 to 83 and 106 to 61 per 100,000 population for males and females, respectively.

Variation among population groups

Aboriginal and Torres Strait Islander people

In 2017–2019, heart failure or cardiomyopathy was an underlying or associated cause of death for 1,089 Indigenous Australians in the jurisdictions with adequate Indigenous identification.

The age-standardised Indigenous death rate (140 per 100,000 population) was 2.0 times as high as the non-Indigenous rate (70 per 100,000 population). Indigenous males and females had heart failure and cardiomyopathy death rates 1.8 and 2.2 times as high as non-Indigenous males and females (Figure 6).

Socioeconomic group

In 2017–2019, the age-standardised death rate for heart failure or cardiomyopathy as an underlying or associated cause was 1.6 times as high for people living in the lowest socioeconomic areas compared with those living in the highest socioeconomic areas (88 and 56 per 100,000 population).

The disparity was slightly higher for males (1.6 times as high) than females (1.5 times as high) (Figure 6).

Remoteness area

In 2017–2019, age-standardised heart failure and cardiomyopathy death rates were lowest for those living in Major cities (66 deaths per 100,000 population) and highest for those in Remote and very remote areas (103 per 100,000 population).

Males had higher heart failure and cardiomyopathy death rates than females in all remoteness areas (Figure 6).

Figure 6: Heart failure and cardiomyopathy death rates, underlying or associated cause, by population group and sex, 2017–2019

The horizontal bar chart shows that age-standardised heart failure and cardiomyopathy death rates in 2017–2019 were higher among Indigenous Australians, people living in the lowest socioeconomic areas and people living in Remote and very remote areas.