Deaths from heart failure, one of the nation’s biggest killers, are surging as the population ages and the health of younger generations worsens. The death rate from the debilitating condition rose 20.7% between 2011 and 2017, and is likely to keep climbing sharply, according to a study published today (Wednesday) in the journal JAMA Cardiology.

The rapid aging of the population, together with high rates of obesity and diabetes in all ages, are pushing both the rate and number of deaths from heart failure higher. Most deaths from heart failure occur in older Americans, but they’re rising in adults under 65, too, the study showed. The findings help explain why a decades-long decline in the death rate from cardiovascular disease has slowed substantially since 2011 and started rising in middle-aged people, helping drive down U.S. life expectancy. The number of Americans who are 65 and over rose nearly 23% between 2011 and 2017 to 50.9 million, and is projected to expand another 44% to 73.1 million by 2030, according to the study, citing Census Bureau data.

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