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Global epidemiology and future trends of heart failure

March 2020

March 2020
5

DOI:10.21037/amj.2020.03.03

Authors:

Giuseppe Lippi

University of Verona

Fabian Sanchis-Gomar

Stanford University

Last 28-year trend and current scenario of worldwide epidemiology of HF.

…

Global trends on HF during the last 28 years. (A) Last 28-year trend and current scenario of worldwide epidemiology of HF in different age ranges; (B) last 28-year trend and current scenario of worldwide epidemiology of HF in different SDI regions. HF, heart failure; SDI, socio-demographic index.

…

Current and future trends of HF prevalence in middleto-low and high SDI regions. HF, heart failure; SDI, sociodemographic index.

…

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Page 1 of 6

Introduction

Irrespective of the underlying cause, heart failure (HF)

generates an enormous clinical, societal and economic

burden. Although some population statistics suggested that

the epidemiologic burden of HF may have significantly

decreased between 2000 and 2010 (1), this trend could

not be confirmed in other continental or nationwide

surveys, which showed instead that both the incidence and

prevalence of HF may be increasing especially due to a

constantly growing proportion of population aged 70 years

or older (2-5). Accurate assessment of epidemiologic trends

is vital for optimizing healthcare resources allocation

in a world still plagued by an unprecedented economic

crisis (6). Therefore, in this brief report, we aimed to

provide an objective and concise analysis of the worldwide

epidemiological burden of HF, providing also an estimation

of possible future trends.

Methods

An electronic search was performed in the Global Health

Data Exchange (GHDx) registry, a large database of health-

related data maintained by the Institute for Health Metrics

and Evaluation (7), using the keyword “heart failure”

[International Classification of Diseases 10 (ICD-10)

Code I50] in the category “impairment” combined

with “all causes” in the category “cause”. According to

the Global Burden of Disease (GBD) Collaborators,

HF clinically diagnosed, using structured criteria such

as those of Framingham or the European Society of

Cardiology (ESC) (8,9). Mild HF was then defined as

shortness of breath and fatigue with moderate physical

activity such as walking uphill or more than a quarter-

mile on level ground (disability weight, 0.041; 95%

confidence interval (CI), 0.026–0.062), moderate HF

as is shortness of breath and easy fatigue with minimal

Brief Report

Global epidemiology and future trends of heart failure

Giuseppe Lippi1, Fabian Sanchis-Gomar2

1Section of Clinical Biochemistry, University of Verona, Verona, Italy; 2Department of Physiology, Faculty of Medicine, University of Valencia and

INCLIVA Biomedical Research Institute, Valencia, Spain

Correspondence to: Fabian Sanchis-Gomar, MD, PhD. Department of Physiology, Faculty of Medicine, University of Valencia, Av. Blasco Ibañez 15,

46010 Valencia, Spain. Email: fabian.sanchis@uv.es.

Abstract: Some population statistics suggested that the epidemiologic burden of heart failure (HF) may

have signicantly decreased between 2000 and 2010. However, this trend could not be conrmed in other

continental or nationwide surveys. We aimed to provide an objective and concise analysis of the worldwide

epidemiological burden of HF. An electronic search was performed in Global Health Data Exchange (GHDx)

registry, with the keyword “heart failure”. The current worldwide prevalence of HF is 64.34 million cases (8.52

per 1,000 inhabitants), accounting for 9.91 million years lost due to disability (YLDs) and 346.17 billion US

$ expenditure. YLDs value is marginally higher in men. HF poses the largest burden after 60 years of age

and both prevalence and YLDs have increased by 3.9% and 4.5% in very elderly people during the last 28

years. A linear, direct relationship can be found between socio-demographic index (SDI) and both prevalence

and YLDs of HF. HF is an emerging worldwide threat whose prevalence and health loss burden constantly

increase, especially in the elderly and in people leaving in low-to middle SDI regions. Urgent preventive

interventions shall be prioritized and healthcare resources redesigned around this evolving epidemiology.

Keywords: Heart failure (HF); heart disease; health; epidemiology; mortality

Received: 22 January 2020. Accepted: 27 February 2020.

doi: 10.21037/amj.2020.03.03

View this article at: http://dx.doi.org/10.21037/amj.2020.03.03

AME Medical Journal, 2020Page 2 of 6

physical activity such as walking a short distance (disability

weight, 0.072; 95% CI, 0.047–0.103), whilst severe HF

was defined as shortness of breath and fatigue even at

rest (disability weight, 0.179; 95% CI, 0.122–0.251) (10).

The years lost due to disability (YLDs) was considered

the indicator of disease or risk factor attributable to health

loss, reecting the burden of living with a certain disease or

disability. The database search was then combined with the

epidemiologic variables “year”, “sex”, “age” and “location”

(using “SDI Regions”, where SDI stands for socio-

demographic index).

The output of the electronic search was downloaded in

comma-separated values (CSV), imported into an Excel

file (Microsoft, Redmond, WA, USA) and analyzed with

Analyse-it (Analyse-it Software Ltd, Leeds, UK) and

MedCalc statistical software (MedCalc Software, Ostend,

Belgium). Simple (Pearson’s correlation) regression analyses

were used for assessing potential associations (and their

relative 95% CI) among different epidemiologic measures,

whilst the risk was expressed as odds ratio (OR) and relative

95% CI. The study was performed in accordance with the

Declaration of Helsinki and under the terms of relevant

local legislation.

Results

According to the last searchable GDHx period (i.e., year

2017), the current worldwide prevalence of HF is estimated

at 64.34 million cases (8.52 per 1,000 inhabitants, 29%

of which mild, 19% moderate and 51% severe HF),

accounting for 9.91 million YLDS (11.61 per 1,000 YLDs).

Based on an American Heart Association (AHA) estimation

of 5380 US $ per HF case (11), the current worldwide

economic burden of HF can be estimated at 346.17 billion

US $. The most frequent causes of HF with known etiology

is ischemic heart disease (42.3% of all cases), followed by

chronic obstructive pulmonary disease (37.0%), mitral valve

disease (4.3%), aortic valve disease (3.4%), rheumatic heart

disease (3.0%), myocarditis (2.6%) and endocarditis (1.4%).

The last 28-year trend (i.e., between the years 1990 to 2017)

is shown in Figure 1. A considerable increase has occurred

for both prevalence and YLDs of HF, both trends perfectly

Figure 1 Last 28-year trend and current scenario of worldwide epidemiology of HF.

Cases (×1000)

Time (years)

YLDs (Years Lived with Disability)

Prevalence

13.0

12.5

12.0

11.5

11.0

10.5

10.0

9.5

9.0

8.5

8.0

7.5

7.0

6.5

6.0

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

1016

2030

AME Medical Journal, 2020 Page 3 of 6

matching a third-degree polynomial equation (r=1.000 and

P<0.001 for both). Overall, prevalence and YLDs of HF

have increased by ~36% since the year 1900, and this trend

is not likely to reverse soon. According to estimations based

on the third-degree polynomial equations, prevalence and

YLDs will probably grow to 9.81 per 1,000 inhabitants

(+15.1%) and 12.82 per 1,000 YLDs (+10.4%) by the year

2030, accounting for ~398.44 billion US $ worldwide

expenditure.

Although the prevalence of HF appears significantly

higher in the female sex (9.16 vs. 7.69 per million

inhabitants; OR, 1.19; 95% CI, 1.18–1.20; P<0.001), the

value of YLDs is instead marginally but signicantly higher

in men than in women (11.74 vs. 11.50 per 1,000 YLDs;

OR, 1.02; 95% CI, 1.01–1.03; P<0.001). Both prevalence

and YLDs have remained almost constant between genders

during the last 28 years. The current and last 28-year trend

of prevalence and YLDs of HF in different age groups are

shown in Figure 2A. Overall, HF poses the largest burden

after 60 years of age (81% and 87% of all HF cases and all

YLDs for HF, respectively). The risk of developing HF

is over 20-fold higher in people aged ≥60 years than in

younger subjects (OR: 21.9; 95% CI, 21.8–22.0; P<0.001).

Importantly, the prevalence and YLDs of HF have increased

by 3.9% and 4.5% in very elderly people (i.e., aged

≥80 years) during the last 28 years. The burden of HF in

the different SDI areas is finally shown in Figure 2B. A

linear, direct relationship can be found between SDI and

both prevalence (r=0.94, 95% CI, 0.31–1.00; P=0.019) or

YLDs (r=0.92; 95% CI, 0.20–0.99; P=0.027) of HF.

Though the burden of HF remains higher in high SDI

regions (31% of all HF cases and 28% of all YLDs for HF),

the 28-year trends reveal a −11.2% decreased prevalence in

these regions counterbalanced by a 10.3% increase in low-

to-middle SDI regions. The YLDs trend is very similar,

with a 10.5% decline in high SDI regions occurred during

the last 28 years, counterbalanced by a 10.0% increment in

low-to-middle SDI regions. The last 10-year trend of HF

prevalence seems virtually linear both in high SDI (r=0.999;

P<0.001) and low-to-middle SDI (r=1.000; P<0.001) regions

(Figure 3). By the year 2030, it can hence be estimated that

the prevalence of HF will increase over 50% in low-to-

middle SDI regions, whilst it will decline to ~27% in high

SDI countries, respectively.

Discussion

Although evidence has been provided that the

epidemiologic impact of HF may have decreased during

the past decades (1), more recently published continental

or nationwide studies showed an almost opposite trend

(2-5). The results of our analysis suggest that both

prevalence and health loss (i.e., YLDs) of HF have

constantly increased during the past 28 years on a

worldwide scale, following a path that is unlikely to reverse

in the next 10 years based on our estimations. The recent

AHA projections show that the prevalence of HF in the

US will probably increase from 2.42% in 2012 to 2.97%

in 2030 (11), exhibiting a relative increment of 22.7%

that would perfectly overlap the increment of worldwide

prevalence predicted by our estimation during the same

period of time (7.93 per 1,000 inhabitants in 2012 vs. 9.81

per 100 inhabitants in 2030, +23.7%) (Figure 1). Notably,

this increased population burden will then translate into

an enhanced worldwide expenditure for managing HF

patients, which will reach approximately 400 billion US $ in

2030, thus approximating the gross domestic product of an

entire country like Austria, Ireland or Israel. Although the

sex distribution of HF has not apparently changed during

the last 28 years, with prevalence constantly higher in the

female sex and YLDs slightly larger in men, the impact of

HF in different age ranges has instead signicantly varied,

with an ~4% increase in the very elderly population, as

possible reflection of worldwide population ageing. This

increment has been almost constant and has even sharpened

during the last 10 years (+ ~2%; Figure 2A), which would

hence lead us to estimate that both prevalence and

YLDs will consistently increase over 30% in people aged

≥80 years by the year 2030. Since the higher inpatient

costs for managing HF are those resulting from hospital

readmissions (12), which are up to 4-fold higher in the

elderly (13), it is hence very likely that the epidemic

proportion reached by HF in older individuals may

consistently amplify the usage of healthcare resource for

managing HF in the next 10 years.

The last 28-year trend and the current socioeconomic

distribution of HF around the world deserve special focus.

Although the burden of HF is still largely prevalent in

middle-to-high SDI regions, the recent trend shows that the

distribution may soon change (Figure 2B). More specically,

our analysis shows that the burden of HF has increased

by 3.1% in the last 10 years in low-to-middle SDI regions

(from 43.4% to 46.5% of all worldwide HF cases), which

would allow us to estimate that the burden of this condition

will overcome 50% by the year 2030, thus reversing the

current scenario where HF is more prevalent in middle-

AME Medical Journal, 2020Page 4 of 6

Figure 2 Global trends on HF during the last 28 years. (A) Last 28-year trend and current scenario of worldwide epidemiology of HF

in different age ranges; (B) last 28-year trend and current scenario of worldwide epidemiology of HF in different SDI regions. HF, heart

failure; SDI, socio-demographic index.

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

High SDI

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

1990

1991

1992

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1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Time (years)

>90

85 to 89

80 to 84

75 to 79

70 to 74

65 to 69

60 to 64

55 to 59

50 to 54

<50

Time (years)

Percent of all heart failure cases

Middle-High SDI

Middle SDI

Middle-low SDI

LowSDI

AME Medical Journal, 2020 Page 5 of 6

Figure 3 Current and future trends of HF prevalence in middle-

to-low and high SDI regions. HF, heart failure; SDI, socio-

demographic index.

to-high SDI countries (Figure 3). This prediction will pose

additional challenges, whereby HF in low-income countries

is clinically different from Europe and North America and

its outcome is dramatically influenced by worse health-

care infrastructure availability, as well as by lower care

access and quality (14). This will require definition and

implementation of highly tailored healthcare measures

that may pose a theoretically unsustainable burden on local

healthcare systems in these countries (15).

Conclusions

The results of our analysis attest that HF is an emerging

worldwide threat whose prevalence and health loss burden

are constantly increasing, especially in the elderly and in

people leaving in low SDI regions. Urgent interventions

shall hence be prioritized and scaled up for targeting the

cause of HF and preventing its onset and worsening, as

well as for redesigning healthcare access, infrastructure and

therapies around this evolving epidemiology.

Acknowledgments

Fabian Sanchis-Gomar is supported by a postdoctoral

contract granted by “Subprograma Atracció de Talent -

Contractes Postdoctorals de la Universitat de València”.

Footnote

Conicts of Interest: The authors have no conicts of interest

to declare.

Ethical Statement: The authors are accountable for all

aspects of the work in ensuring that questions related

to the accuracy or integrity of any part of the work are

appropriately investigated and resolved.

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AME Medical Journal, 2020Page 6 of 6

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doi: 10.21037/amj.2020.03.03

Cite this article as: Lippi G, Sanchis-Gomar F. Global

epidemiology and future trends of heart failure. AME Med J

2020.

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Full-text available

Apr 2024

Background—The AAMS open-label clinical study demonstrated safety and feasibility of epicardial transplantation of autologous right atrial appendage micrografts (AAMs) during coronary artery bypass grafting (CABG) surgery. Delivered in an extracellular matrix patch, the study also provided first indications of reduced ischemic scar and increased live ventricular wall thickness associated with AAMs therapy. To further evaluate the initial beneficial effects observed in the AAMS study, we designed the randomized, double-blinded, and placebo-controlled AAMS2 trial. Focusing on patients with ischemic heart failure with reduced ejection fraction (iHFrEF), the AAMS2 trial aims to generate state-of-the-art structural and functional imaging data on the myocardium treated with an AAMs-patch during CABG. Methods—The AAMS2 trial recruits iHFrEF patients who are set to undergo non-urgent CABG and present with a myocardial scar in preoperative cardiac magnetic resonance (CMR) with late gadolinium enhancement. Patients are randomized evenly (1:1) to receive an collagen-based matrix patch (Hemopatch®), with or without AAMs, epicardially onto the scar border. The primary endpoints at 6 months post-operatively are the effect change on the myocardial scar size by the AAMs-patch transplantation site, as assessed by CMR with late gadolinium enhancement and change in blood N-terminal-pro-BNP in the timeframe. The trial’s secondary endpoints address feasibility, safety, echocardiography, quality of life, symptom scaling, and 6-minute walk test. Discussion—Data from the AAMS2 trial provide the first randomized, blinded, and placebo-controlled evaluation of efficacy on epicardial AAMs transplantation for iHFrEF. This data then enables the rational design of larger AAMs therapeutic efficacy-addressing trial(s). Trial Registration: ClinicalTrials.gov, NCT05632432, registered 30 November 2022, https://clinicaltrials.gov/study/NCT05632432

Banking for health: The role of financial sector actors in investing in global health

Article

Full-text available

May 2018

The world faces multiple health financing challenges as the global health burden evolves. Countries have set an ambitious health policy agenda for the next 15 years with prioritisation of universal health coverage under the Sustainable Development Goals. The scale of investment needed for equitable access to health services means global health is one of the key economic opportunities for decades to come. New financing partnerships with the private sector are vital. The aim of this study is to unlock additional financing sources, acknowledging the imperative to link financial returns to the providers of capital, and create profitable, sustainable financing structures. This paper outlines the global health investment opportunity exploring intersections of financial and health sector interests, and the role investment in health can play in economic development. Considering increasing demand for impact investments, the paper explores responsible financing initiatives and expansion of the global movement for sustainable capital markets. Adding an explicit health component (H) to the Environmental, Social and Governance (ESG) investment criteria, creating the ESG+H initiative, could serve as catalyst for the inclusion of health criteria into mainstream financial actors’ business practices and investment objectives. The conclusion finds that health considerations directly impact profitability of the firm and therefore should be incorporated into financial analysis. Positive assessment of health impact, at a broad societal or environmental level, as well as for a firm’s employees can become a value enhancing competitive advantage. An ESG+H framework could incorporate this into mainstream financial decision-making and into scalable investment products.

Cost-of-illness studies in heart failure: A systematic review 2004-2016

Article

Full-text available

May 2018
BMC Cardiovasc Disord

Background Heart failure is a major and growing medical and economic problem worldwide as 1–2% of the healthcare budget are spent for heart failure. The prevalence of heart failure has increased over the past decades and it is expected that there will be further raise due to the higher proportion of elderly in the western societies. In this context cost-of-illness studies can significantly contribute to a better understanding of the drivers and problems which lead to the increasing costs in heart failure.The aim of this study was to perform a systematic review of published cost-of-illness studies related to heart failure to highlight the increasing cost impact of heart failure. MethodsA systematic review was conducted from 2004 to 2016 to identify cost-of-illness studies related to heart failure, searching PubMed (Medline), Cochrane, Science Direct (Embase), Scopus and CRD York Database. ResultsOf the total of 16 studies identified, 11 studies reported prevalence-based estimates, 2 studies focused on incidence-based data and 3 articles presented both types of cost data. A large variation concerning cost components and estimates can be noted. Only three studies estimated indirect costs. Most of the included studies have shown that the costs for hospital admission are the most expensive cost element. Estimates for annual prevalence-based costs for heart failure patients range from $868 for South Korea to $25,532 for Germany. The lifetime costs for heart failure patients have been estimated to $126.819 per patient. Conclusions Our review highlights the considerable and growing economic burden of heart failure on the health care systems. The cost-of-illness studies included in this review show large variations in methodology used and the cost results vary consequently. High quality data from cost-of-illness studies with a robust methodology applied can inform policy makers about the major cost drivers of heart failure and can be used as the basis of further economic evaluations.

National Trends in Admission and In‐Hospital Mortality of Patients With Heart Failure in the United States (2001–2014)

Article

Full-text available

Dec 2017

Background: To investigate heart failure (HF) hospitalization trends in the United States and change in trends after publication of management guidelines. Methods and results: Using data from the National Inpatient Sample and the US Census Bureau, annual national estimates in HF admissions and in-hospital mortality were estimated for years 2001 to 2014, during which an estimated 57.4 million HF-associated admissions occurred. Rates (95% confidence intervals) of admissions and in-hospital mortality among primary HF hospitalizations declined by an average annual rate of 3% (2.5%-3.5%) and 3.5% (2.9%-4.0%), respectively. Compared with 2001 to 2005, the average annual rate of decline in primary HF admissions was more in 2006 to 2009 (ie, 3.4% versus 1.1%; P=0.02). In 2010 to 2014, primary HF admission continued to decline by an average annual rate of 4.3% (95% confidence interval, 3.9%-5.1%), but this was not significantly different from 2006 to 2009 (P=0.14). In contrast, there was no further decline in in-hospital mortality trend after the guideline-release years. For hospitalizations with HF as the secondary diagnosis, there was an upward trend in admissions in 2001 to 2005. However, the trend began to decline in 2006 to 2009, with an average annual rate of 2.4% (95% confidence interval, 0.8%-4%). Meanwhile, there was a consistent decline in in-hospital mortality by an average annual rate of 3.7% (95% confidence interval, 3.3%-4.2%) during the study period, but the decline was more in 2006 to 2009 compared with 2001 to 2005 (ie, 5.4% versus 3.4%; P<0.001). Beyond 2009, admission and in-hospital mortality rates continued to decline, although this was not significantly better than the preceding interval. Conclusions: From 2001 to 2014, HF admission and in-hospital mortality rates declined significantly in the United States; the greatest improvements coincided with the publication of the 2005 American College of Cardiology/American Heart Association HF guidelines.

Temporal trends and patterns in heart failure incidence: A population-based study of 4 million individuals

Article

Full-text available

Nov 2017

Background: Large-scale and contemporary population-based studies of heart failure incidence are needed to inform resource planning and research prioritisation but current evidence is scarce. We aimed to assess temporal trends in incidence and prevalence of heart failure in a large general population cohort from the UK, between 2002 and 2014. Methods: For this population-based study, we used linked primary and secondary electronic health records of 4 million individuals from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex. Eligible patients were aged 16 years and older, had contributed data between Jan 1, 2002, and Dec 31, 2014, had an acceptable record according to CPRD quality control, were approved for CPRD and Hospital Episodes Statistics linkage, and were registered with their general practice for at least 12 months. For patients with incident heart failure, we extracted the most recent measurement of baseline characteristics (within 2 years of diagnosis) from electronic health records, as well as information about comorbidities, socioeconomic status, ethnicity, and region. We calculated standardised rates by applying direct age and sex standardisation to the 2013 European Standard Population, and we inferred crude rates by applying year-specific, age-specific, and sex-specific incidence to UK census mid-year population estimates. We assumed no heart failure for patients aged 15 years or younger and report total incidence and prevalence for all ages (>0 years). Findings: From 2002 to 2014, heart failure incidence (standardised by age and sex) decreased, similarly for men and women, by 7% (from 358 to 332 per 100 000 person-years; adjusted incidence ratio 0·93, 95% CI 0·91-0·94). However, the estimated absolute number of individuals with newly diagnosed heart failure in the UK increased by 12% (from 170 727 in 2002 to 190 798 in 2014), largely due to an increase in population size and age. The estimated absolute number of prevalent heart failure cases in the UK increased even more, by 23% (from 750 127 to 920 616). Over the study period, patient age and multi-morbidity at first presentation of heart failure increased (mean age 76·5 years [SD 12·0] to 77·0 years [12·9], adjusted difference 0·79 years, 95% CI 0·37-1·20; mean number of comorbidities 3·4 [SD 1·9] vs 5·4 [2·5]; adjusted difference 2·0, 95% CI 1·9-2·1). Socioeconomically deprived individuals were more likely to develop heart failure than were affluent individuals (incidence rate ratio 1·61, 95% CI 1·58-1·64), and did so earlier in life than those from the most affluent group (adjusted difference -3·51 years, 95% CI -3·77 to -3·25). From 2002 to 2014, the socioeconomic gradient in age at first presentation with heart failure widened. Socioeconomically deprived individuals also had more comorbidities, despite their younger age. Interpretation: Despite a moderate decline in standardised incidence of heart failure, the burden of heart failure in the UK is increasing, and is now similar to the four most common causes of cancer combined. The observed socioeconomic disparities in disease incidence and age at onset within the same nation point to a potentially preventable nature of heart failure that still needs to be tackled. Funding: British Heart Foundation and National Institute for Health Research.

Global mortality variations in patients with heart failure: Results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study

Article

Full-text available

May 2017

Background: Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTER-CHF) study, we aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle East, southeast Asia and South America; we also explored demographic, clinical, and socioeconomic variables associated with mortality. Methods: We enrolled consecutive patients with heart failure (3695 [66%] clinic outpatients, 2105 [34%] hospital in patients) from 108 centres in six geographical regions. We recorded baseline demographic and clinical characteristics and followed up patients at 6 months and 1 year from enrolment to record symptoms, medications, and outcomes. Time to death was studied with Cox proportional hazards models adjusted for demographic and clinical variables, medications, socioeconomic variables, and region. We used the explained risk statistic to calculate the relative contribution of each level of adjustment to the risk of death. Findings: We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). Regional differences persisted after multivariable adjustment. Independent predictors of mortality included cardiac variables (New York Heart Association Functional Class III or IV, previous admission for heart failure, and valve disease) and non-cardiac variables (body-mass index, chronic kidney disease, and chronic obstructive pulmonary disease). 46% of mortality risk was explained by multivariable modelling with these variables; however, the remainder was unexplained. Interpretation: Marked regional differences in mortality in patients with heart failure persisted after multivariable adjustment for cardiac and non-cardiac factors. Therefore, variations in mortality between regions could be the result of health-care infrastructure, quality and access, or environmental and genetic factors. Further studies in large, global cohorts are needed. Funding: The study was supported by Novartis.

A Contemporary Appraisal of the Heart Failure Epidemic in Olmsted County, Minnesota, 2000 to 2010

Article

Full-text available

Apr 2015

Heart failure (HF) is commonly referred to as an epidemic, posing major clinical and public health challenges. Yet, contemporary data on its magnitude and implications are scarce. To evaluate recent trends in HF incidence and outcomes overall and by preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF). Incidence rates of HF in Olmsted County, Minnesota (population, approximately 144 248), between January 1, 2000, and December 31, 2010, were assessed. Patients identified with incident HF (n = 2762) (mean age, 76.4 years; 43.1% male) were followed up for all-cause and cause-specific hospitalizations (through December 2012) and death (through March 2014). The age- and sex-adjusted incidence of HF declined substantially from 315.8 per100 000 in 2000 to 219.3 per 100 000 in 2010 (annual percentage change, -4.6), equating to a rate reduction of 37.5% (95% CI, -29.6% to -44.4%) over the last decade. The incidence declined for both HF types but was greater (interaction P = .08) for HFrEF (-45.1%; 95% CI, -33.0% to -55.0%) than for HFpEF (-27.9%; 95% CI, -12.9% to -40.3%). Mortality was high (24.4% for age 60 years and 54.4% for age 80 years at 5 years of follow-up), frequently ascribed to noncardiovascular causes (54.3%), and did not decline over time. The risk of cardiovascular death was lower for HFpEF than for HFrEF (multivariable-adjusted hazard ratio, 0.79; 95% CI, 0.67-0.93), whereas the risk of noncardiovascular death was similar (1.07; 95% CI, 0.89-1.29). Hospitalizations were common (mean, 1.34; 95% CI, 1.25-1.44 per person-year), particularly among men, and did not differ between HFpEF and HFrEF. Most hospitalizations (63.0%) were due to noncardiovascular causes. Hospitalization rates for cardiovascular causes did not change over time, whereas those for noncardiovascular causes increased. Over the last decade, the incidence of HF declined substantially, particularly for HFrEF, contrasting with no apparent change in mortality. Noncardiovascular conditions have an increasing role in hospitalizations and remain the most frequent cause of death. These results underscore the need to augment disease-centric management approaches with holistic strategies to reduce the population burden of HF.

Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality

Article

Full-text available

Apr 2015
NEW ENGL J MED

Global deaths from cardiovascular disease are increasing as a result of population growth, the aging of populations, and epidemiologic changes in disease. Disentangling the effects of these three drivers on trends in mortality is important for planning the future of the health care system and benchmarking progress toward the reduction of cardiovascular disease. We used mortality data from the Global Burden of Disease Study 2013, which includes data on 188 countries grouped into 21 world regions. We developed three counterfactual scenarios to represent the principal drivers of change in cardiovascular deaths (population growth alone, population growth and aging, and epidemiologic changes in disease) from 1990 to 2013. Secular trends and correlations with changes in national income were examined. Global deaths from cardiovascular disease increased by 41% between 1990 and 2013 despite a 39% decrease in age-specific death rates; this increase was driven by a 55% increase in mortality due to the aging of populations and a 25% increase due to population growth. The relative contributions of these drivers varied by region; only in Central Europe and Western Europe did the annual number of deaths from cardiovascular disease actually decline. Change in gross domestic product per capita was correlated with change in age-specific death rates only among upper-middle income countries, and this correlation was weak; there was no significant correlation elsewhere. The aging and growth of the population resulted in an increase in global cardiovascular deaths between 1990 and 2013, despite a decrease in age-specific death rates in most regions. Only Central and Western Europe had gains in cardiovascular health that were sufficient to offset these demographic forces. (Funded by the Bill and Melinda Gates Foundation and others.).

The year in cardiology 2018: heart failure

Article

Feb 2019
EUR HEART J

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

Article

Jan 2019

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC

Article

May 2016

ACC/AHA : American College of Cardiology/American Heart Association ACCF/AHA : American College of Cardiology Foundation/American Heart Association ACE : angiotensin-converting enzyme ACEI : angiotensin-converting enzyme inhibitor ACS : acute coronary syndrome AF : atrial fibrillation

Global epidemiology and future trends of heart failure

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