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Mortality from Congestive Heart Failure -- United States, 1980-1990

In the United States, congestive heart failure (CHF) was the underlying cause of death for approximately 38,000 persons in 1990; of those deaths, approximately 92% were among persons aged greater than or equal to 65 years. CHF, a clinical syndrome defined as a chronic inadequate contraction of the heart muscle resulting in insufficient cardiac output, is a manifestation of one or more underlying conditions, including systemic or pulmonary hypertension or a history of other heart diseases (e.g., myocardial infarction, atherosclerosis, cardiomyopathy, congenital heart disease, or rheumatic fever). The long-term prognosis of CHF depends on the underlying condition and the response of that condition to treatment. Despite declines in death rates for ischemic heart disease and cerebrovascular disease (1,2), improvements in detection and treatment of hypertension (3), and considerable advances in the diagnosis and management of CHF (4), mortality from CHF has increased since 1980 (5). This report summarizes trends in CHF mortality in the United States during 1980-1990 and presents state-specific mortality data for 1990 (the most recent year for which such data are available).

Public-use mortality data tapes compiled by CDC's National Center for Health Statistics and population estimates from the U.S. Bureau of the Census were used to calculate crude and age-adjusted CHF death rates for the U.S. population. CHF deaths were defined as deaths for which the underlying cause was listed on the death certificate as International Classification of Diseases, Ninth Revision, codes 428.0-428.9. State- and group-specific age-adjusted estimates were standardized to the 1980 U.S. population. Race-specific denominator data were available only for blacks and whites.

In 1990, a total of 37,935 deaths resulted from CHF. Crude death rates for CHF per 100,000 persons were directly proportionate to age. For persons aged greater than or equal to 85 years, the crude death rate was 559.1 -- fivefold higher than the rate for persons aged 75-84 years (124.7) and 18-fold higher than that for persons aged 65-74 years (31.6). The age-adjusted death rate for CHF among persons aged greater than or equal to 65 years was 143.9 for black men, 117.8 for white men, 113.4 for black women, and 97.5 for white women.

Crude death rates for CHF increased during 1980-1988 for persons aged greater than or equal to 65 years (Figure_1); rates declined slightly during 1989-1990. For persons aged greater than or equal to 65 years, age-adjusted death rates for CHF increased during 1980-1988 for each of the race and sex groups (Figure_2); rates were higher among blacks and men.

In 1990, age-adjusted CHF death rates varied substantially among the states and ranged from 3.7 (Florida) to 31.5 (Alabama) (Table_1). For persons aged greater than or equal to 65 years, state-specific CHF death rates ranged from 29.9 (Florida) to 246.2 (Alabama).

Reported by: Cardiovascular Health Studies Br and Statistics Br, Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: In the United States, an estimated 1-2 million persons aged 25-74 years are affected by CHF (6). The impact of CHF is particularly severe among the elderly because of the emotional and economic burdens (e.g., functional disability, long-term pharmacologic therapy, and frequent hospitalizations) associated with the syndrome. In addition, the prognosis for CHF is poor: for example, of newly diagnosed cases in Rochester, Minnesota, in 1981, survival following diagnosis was 80% at 3 months, 66% at 1 year, and 30% at 8 years (7).

The findings in this report document substantial increases in CHF death rates during 1980-1990 among persons in older age groups. Potential explanations for these increases, and for increases in hospitalization rates for CHF, include the increasing average age of the U.S. population and the longer survival of persons with hypertension or symptomatic cardiac diseases who subsequently develop CHF at an older age (3,5,8). Race-specific variations in CHF death rates especially may reflect the substantially higher prevalence and greater severity of hypertension among blacks. In addition, hospitalization (8) and death rates for CHF (5) were higher for younger blacks than for whites, suggesting an earlier onset of disease and perhaps greater severity of CHF among blacks. Potential explanations for regional variations in CHF mortality include differences in prevalences of underlying conditions, in access to early diagnosis and/or therapeutic management of CHF and its underlying conditions, and in coding of death certificates.

Because the U.S. Standard Certificate of Death was revised in 1989 to improve specificity of causes of death (9), the declines in CHF mortality during 1989 and 1990 may reflect deaths attributed to specific precipitating diseases rather than actual declines in CHF (5). In addition, the derivation of rates based on underlying cause-of-death listings also may account for an underestimation of CHF-related deaths: for example, in 1988, CHF was mentioned on death certificates as a contributing or sec- ondary cause approximately five times more often than as the underlying cause (5).

Despite progress in the treatment of CHF (4), public health efforts should continue to target prevention and treatment of the underlying conditions associated with increased risk for CHF. For most U.S. residents, primary prevention of CHF includes adherence to lifestyles associated with prevention of hypertension and myocardial infarction (e.g., reduced dietary fat and/or sodium, weight maintenance, regular physical activity, and smoking cessation).


  1. CDC. Trends in ischemic heart disease mortality -- United States, 1980-1988. MMWR 1992; 41:548-9,555-6.

  2. CDC. Cerebrovascular disease mortality and Medicare hospitalization -- United States, 1980-1990. MMWR 1992;41:477-80.

  3. Yusuf S, Thom T, Abbott RD. Changes in hypertension treatment and in congestive heart failure mortality in the United States. Hypertension 1989;13(suppl 5):I-74-I-79.

  4. Armstrong PW, Moe GW. Medical advances in the treatment of congestive heart failure. Circulation 1993;88:2941-52.

  5. Gillum RF. Epidemiology of heart failure in the United States. Am Heart J 1993;126:1042-7.

  6. Schocken DD, Arrieta MI, Leaverton PE, Ross EA. Prevalence and mortality of congestive heart failure in the United States. J Am Coll Cardiol 1992;20:301-6.

  7. Rodeheffer RJ, Jacobsen SJ, Gersh BJ, et al. The incidence and prevalence of congestive heart failure in Rochester, Minnesota. Mayo Clin Proc 1993;68:1143-50.

  8. Ghali JK, Cooper R, Ford E. Trends in hospitalization rates for heart failure in the United States, 1973-1986: evidence for increasing population prevalence. Arch Intern Med 1990;150:769-73.

  9. NCHS. Advance report of final mortality statistics, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 8, suppl 2).


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TABLE 1. Number of deaths from and age-adjusted death rates for congestive heart
failure* among persons aged >=65 years+ and overall &, by state -- United States, 1990
                           Persons aged >=65 yrs        Overall
                          -----------------------    ---------------
   State                    No.         Rate         No.        Rate
    Alabama                  1,322      246.2        1,464      31.5
    Alaska                      12       72.9           15       9.2
    Arizona                    454       99.5          502      12.7
    Arkansas                   706      186.5          758      23.4
    California               1,791       55.4        1,942       6.9
    Colorado                   170       48.6          184       6.0
    Connecticut                469       96.6          483      11.4
    Delaware                    89      112.1           92      13.2
    District of Columbia        95      117.6          118      17.6
    Florida                    722       29.9          766       3.7
    Georgia                    949      145.5        1,056      18.4
    Hawaii                      83       72.9           90       8.9
    Idaho                      140      110.2          150      13.7
    Illinois                 1,997      129.3        2,145      16.0
    Indiana                  1,174      155.7        1,267      19.4
    Iowa                       452       85.2          462      10.0
    Kansas                     630      150.0          656      18.1
    Kentucky                   913      184.7        1,012      23.7
    Louisiana                  771      161.0          887      21.3
    Maine                      170       92.5          185      11.8
    Maryland                   597      116.5          654      14.5
    Massachusetts            1,168      126.2        1,235      15.5
    Michigan                 1,246      107.9        1,314      13.0
    Minnesota                  659       98.4          681      11.7
    Mississippi                742      216.7          809      27.4
    Missouri                 1,018      124.0        1,090      15.5
    Montana                    165      144.7          172      17.4
    Nebraska                   435      155.9          468      19.9
    Nevada                     152      143.3          175      18.1
    New Hampshire              148      107.0          157      13.0
    New Jersey                 805       76.7          866       9.5
    New Mexico                 174      108.2          185      13.0
    New York                 2,328       91.2        2,514      11.4
    North Carolina             768       96.3          832      11.9
    North Dakota               161      141.7          170      17.6
    Ohio                     1,787      121.4        1,914      15.0
    Oklahoma                   804      169.0          858      20.9
    Oregon                     411       97.7          423      11.5
    Pennsylvania             2,229      118.6        2,412      14.9
    Rhode Island                92       56.6           96       6.8
    South Carolina             495      132.8          568      17.3
    South Dakota               145      113.8          154      14.3
    Tennessee                  595       92.2          650      11.6
    Texas                    1,557       86.9        1,756      11.2
    Utah                       231      149.5          242      17.8
    Vermont                     69       91.3           73      11.1
    Virginia                   978      147.4        1,094      18.8
    Washington                 641      104.7          665      12.4
    West Virginia              444      159.2          483      20.1
    Wisconsin                  856      113.9          907      14.0
    Wyoming                     83      167.9           84       19.3

    Total                   35,092      106.4       37,935       13.3
* International Classification of Diseases, Ninth Revision, codes 428.0-428.9.
+Per 100,000 population; standardized to the 1980 U.S. Bureau of the Census population aged
>=65 years.
&Per 100,000 population; standardized to the 1980 U.S. Bureau of the Census population.

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