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Original research
Contrasting trends in heart failure incidence in younger and older New Zealanders, 2006–2018
  1. Daniel Z L Chan1,2,
  2. Andrew Kerr1,3,
  3. Corina Grey3,4,
  4. Vanessa Selak3,
  5. Mildred Ai Wei Lee1,
  6. Mayanna Lund1,
  7. Katrina Poppe3,
  8. Rob N Doughty2,5
  1. 1 Cardiology, Counties Manukau District Health Board, Auckland, New Zealand
  2. 2 Greenlane Cardiovascular Service, Auckland District Health Board, Auckland, New Zealand
  3. 3 Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
  4. 4 Performance Improvement, Auckland District Health Board, Auckland, New Zealand
  5. 5 Department of Medicine, University of Auckland, Auckland, New Zealand
  1. Correspondence to Dr Daniel Z L Chan, Cardiology, Auckland District Health Board, Auckland, New Zealand; DChan{at}


Objective Studies indicate that age-standardised heart failure (HF) incidence has been decreasing internationally; however, contrasting trends in different age groups have been reported, with rates increasing in younger people and decreasing in the elderly. We aimed to describe age-specific trends in HF incidence in New Zealand (NZ).

Methods In this nationwide data linkage study, we used routinely collected hospitalisation data to identify incident HF hospitalisations in NZ residents aged ≥20 years between 2006 and 2018. Age-specific and age-standardised incidence rates were calculated for each calendar year. Joinpoint regression was used to compare incidence trends.

Results 116 113 incident HF hospitalisations were identified over the 13-year study period. Between 2006 and 2013, age-standardised incidence decreased from 403 to 323 per 100 000 (annual percentage change (APC) −2.6%, 95% CI −3.6 to −1.6%). This reduction then plateaued between 2013 and 2018 (APC 0.8%, 95% CI −0.8 to 2.5%). Between 2006 and 2018, rates in individuals aged 20–49 years old increased by 1.5% per year (95% CI 0.3 to 2.7%) and decreased in those aged ≥80 years old by 1.2% per year (95% CI −1.7 to −0.7%). Rates in individuals aged 50–79 years old initially declined from 2006 to 2013, and then remained stable or increased from 2013 to 2018. The proportion of HF hospitalisations associated with ischaemic heart disease decreased from 35.1% in 2006 to 28.0% in 2018.

Conclusion HF remains an important problem in NZ. The decline in overall incidence has plateaued since 2013 due to increasing rates of HF in younger age groups despite an ongoing decline in the elderly.

  • heart failure
  • epidemiology

Data availability statement

Data are available upon reasonable request.

Statistics from

Data availability statement

Data are available upon reasonable request.

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  • Contributors All authors were involved in planning, data acquisition, analysis, interpretation, writing and review of the work pertaining to this manuscript. DC was responsible for overall context as the gurantor and accepts full responsibility for the work and conduct of the study, had access to the data and controlled the decision to publish.

  • Funding DZLC is supported by the AH Couch Trust. CG and VS are supported by the New Zealand Heart Foundation and Healthier Lives (National Science Challenge). KP is supported by a Heart Foundation Hynds Senior Fellowship. RND is the holder of the NZ Heart Foundation Chair of Heart Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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