Epidemiología de la insuficiencia cardiaca en España en los últimos 20 años
TL;DR: Los cambios temporales en the codificacion diagnostica podrian explicar parte del aumento en los ingresos hospitalarios and del descenso in the mortalidad por insuficiencia cardiaca, aunque hay indicios of that the adherencia a las guias of practica clinica puede haber reducido su mortalida.
Abstract: Resumen La insuficiencia cardiaca en un problema sanitario de primer orden en nuestro pais, aunque no disponemos de cifras que permitan dimensionar su impacto con exactitud por falta de estudios con diseno apropiado. Frente a una prevalencia de insuficiencia cardiaca del 2% en otros paises europeos y en Estados Unidos, los estudios en Espana arrojan cifras del 5%, probablemente a causa de sus limitaciones metodologicas. La insuficiencia cardiaca consume enormes recursos sanitarios: es la primera causa de hospitalizacion de mayores de 65 anos y representa el 3% de todos los ingresos hospitalarios y el 2,5% del coste de la asistencia sanitaria. Hay dos patrones de insuficiencia cardiaca, uno con funcion sistolica preservada, mas asociado a la hipertension, y otro con funcion deprimida, mas relacionado con la cardiopatia isquemica. En 2010, la insuficiencia cardiaca constituyo el 3% del total de defunciones de varones y el 10% de las de mujeres. La tasa de mortalidad por insuficiencia cardiaca ha ido reduciendose en los ultimos anos. Los cambios temporales en la codificacion diagnostica podrian explicar parte del aumento en los ingresos hospitalarios y del descenso en la mortalidad por insuficiencia cardiaca, aunque hay indicios de que la adherencia a las guias de practica clinica puede haber reducido su mortalidad.
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TL;DR: A contemporary overview on the global burden of HF is provided, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
Abstract: Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the aging of the population, improved treatment of and survival with ischemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
189 citations
TL;DR: In this paper , the authors provide a contemporary overview on the global burden of heart failure, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide, and provide a comprehensive overview of the available evidence-based therapies for patients with heart failure.
Abstract: Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
171 citations
TL;DR: Trends of HF‐related hospitalizations, hospital days and in‐hospital deaths during a 14‐year period (2000–2013) in Germany are analyzed.
Abstract: Aims
Considerable differences in the long-term trends of heart failure (HF) exist between different countries. To extend the existing knowledge on HF epidemiology in Germany, we analysed trends of HF-related hospitalizations, hospital days and in-hospital deaths during a 14-year period (2000–2013).
Methods and results
Data were derived from the official German Federal Health Monitoring System, which includes an annual and complete enumeration of inpatients at the time of discharge from the hospital. HF cases were identified by the primary diagnosis code for HF (I50). From 2000 to 2013, the absolute number of HF-related hospitalizations increased by 65.4% (239 694–396 380 cases) and by 28.4% after age-standardization (261–335 per 100 000 population). Accordingly, the absolute number of HF-related hospital days increased by 22.1% (3.4–4.2 million hospital days), despite a marked decrease by 25.9% in average length of stay (14.3–10.6 days). With approximately 35 000 in-hospital deaths (∼45 per 100 000 population), the annual number of HF-related in-hospital deaths remained consistently high, and in-hospital mortality rate in HF patients constituted 9.3% in 2013. Patients aged >65 years were disproportionately affected. In 2013, HF was the leading cause of disease-related hospitalizations and in-hospital deaths, representing 2.1% and 8.8% of all cases, respectively.
Conclusion
In Germany, the burden of HF is growing further, and the risk of death in HF remains high. These trends can only be partly attributed to demographic developments suggesting an exigent need for increased awareness and enhanced efforts in the prevention and management of HF.
111 citations
TL;DR: La implantacion of programas multidisciplinarios para the gestion of the insuficiencia cardiaca that integran hospital y comunidad es factible y se asocia a una reduccion significativa of the morbimortalidad of los pacientes.
Abstract: Introduccion y objetivos
Los programas de insuficiencia cardiaca han demostrado su eficacia en ensayos clinicos, aunque su aplicabilidad en un entorno de practica real es mas controvertida. Este estudio evalua la factibilidad y la eficacia de un programa integrado hospital-atencion primaria parala gestion de pacientes con insuficiencia cardiaca en un area integral de salud de 309.345 habitantes.
Metodos
Para el analisis, se incluyo a todos los pacientes consecutivos ingresados por insuficiencia cardiaca como diagnostico principal y dados de alta vivos en todos los hospitales de Cataluna durante el periodo 2005-2011, en el que se implanto el programa y se comparo la mortalidad y los reingresos entre los pacientes expuestos al programa y todos los pacientes de las demas areas integrales de salud del Servei Catala de la Salut.
Resultados
Se incluyo en el estudio a 56.742 pacientes. Se produjeron 181.204 hospitalizaciones y 30.712 defunciones en ese periodo. En los analisis ajustados, los 2.083 pacientes expuestos al programa, respecto los 54.659 pacientes de las otras areas sanitarias, tuvieron menor riesgo de muerte (hazard ratio = 0,92 [intervalo de confianza del 95%, 0,86-0,97]; p = 0,005), menor riesgo de reingreso clinicamente relacionado (hazard ratio = 0,71 [intervalo de confianza del 95%, 0,66-0,76]; p < 0,001) y menor riesgo de rehospitalizacion por insuficiencia cardiaca (hazard ratio = 0,86 [intervalo de confianza del 95%, 0,80-0,94]; p < 0,001). Se observo que el impacto positivo en la morbimortalidad fue mas notorio en el periodo de consolidacion del programa.
Conclusiones
La implantacion de programas multidisciplinarios para la gestion de la insuficiencia cardiaca que integran hospital y comunidad es factible y se asocia a una reduccion significativa de la morbimortalidad de los pacientes.
109 citations
TL;DR: Among patients managed in the setting of a comprehensive HF programme, the addition of telemedicine may result in better outcomes and reduction of costs.
Abstract: BackgroundThe role of telemedicine in the management of patients with chronic heart failure (HF) has not been fully elucidated. We hypothesized that multidisciplinary comprehensive HF care could achieve better results when it is delivered using telemedicine.Methods and resultsIn this study, 178 eligible patients with HF were randomized to either structured follow-up on the basis of face-to-face encounters (control group, 97 patients) or delivering health care using telemedicine (81 patients). Telemedicine included daily signs and symptoms based on telemonitoring and structured follow-up by means of video or audio-conference. The primary end-point was non-fatal HF events after six months of follow-up. The median age of the patients was 77 years, 41% were female, and 25% were frail patients. The hazard ratio for the primary end-point was 0.35 (95% confidence interval (CI), 0.20–0.59; p-value < 0.001) in favour of telemedicine. HF readmission (hazard ratio 0.39 (0.19–0.77); p-value=0.007) and cardiovascular ...
86 citations
References
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TL;DR: The prevalence of heart failure with preserved ejection fraction increased over a 15-year period, while the rate of death from this disorder remained unchanged, and trends underscore the importance of this growing public health problem.
Abstract: Background The prevalence of heart failure with preserved ejection fraction may be changing as a result of changes in population demographics and in the prevalence and treatment of risk factors for heart failure. Changes in the prevalence of heart failure with preserved ejection fraction may contribute to changes in the natural history of heart failure. We performed a study to define secular trends in the prevalence of heart failure with preserved ejection fraction among patients at a single institution over a 15-year period. Methods We studied all consecutive patients hospitalized with decompensated heart failure at Mayo Clinic Hospitals in Olmsted County, Minnesota, from 1987 through 2001. We classified patients as having either preserved or reduced ejection fraction. The patients were also classified as community patients (Olmsted County residents) or referral patients. Secular trends in the type of heart failure, associated cardiovascular disease, and survival were defined. Results A total of 6076 patients with heart failure were discharged over the 15-year period; data on ejection fraction were available for 4596 of these patients (76 percent). Of these, 53 percent had a reduced ejection fraction and 47 percent had a preserved ejection fraction. The proportion of patients with the diagnosis of heart failure with preserved ejection fraction increased over time and was significantly higher among community patients than among referral patients (55 percent vs. 45 percent). The prevalence rates of hypertension, atrial fibrillation, and diabetes among patients with heart failure increased significantly over time. Survival was slightly better among patients with preserved ejection fraction (adjusted hazard ratio for death, 0.96; P=0.01). Survival improved over time for those with reduced ejection fraction but not for those with preserved ejection fraction. Conclusions The prevalence of heart failure with preserved ejection fraction increased over a 15-year period, while the rate of death from this disorder remained unchanged. These trends underscore the importance of this growing public health problem.
3,823 citations
TL;DR: In the community, systolic dysfunction is frequently present in individuals without recognized CHF and diastolic dysfunction as rigorously defined by comprehensive Doppler techniques is common, often not accompanied by recognizedCHF, and associated with marked increases in all-cause mortality.
Abstract: Context Approximately half of patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (EF). Yet, the prevalence of diastolic dysfunction and its relation to systolic dysfunction and CHF in the community remain undefined. Objectives To determine the prevalence of CHF and preclinical diastolic dysfunction and systolic dysfunction in the community and determine if diastolic dysfunction is predictive of all-cause mortality. Design, Setting, Participants Cross-sectional survey of 2042 randomly selected residents of Olmsted County, Minnesota, aged 45 years or older from June 1997 through September 2000. Main Outcome Measures Doppler echocardiographic assessment of systolic and diastolic function. Presence of CHF diagnosis by review of medical records with designation as validated CHF if Framingham criteria are satisfied. Subjects without a CHF diagnosis but with diastolic or systolic dysfunction were considered as having either preclinical diastolic or preclinical systolic dysfunction. Results The prevalence of validated CHF was 2.2% (95% confidence interval [CI], 1.6%-2.8%) with 44% having an EF higher than 50%. Overall, 20.8% (95% CI, 19.0%-22.7%) of the population had mild diastolic dysfunction, 6.6% (95% CI, 5.5%-7.8%) had moderate diastolic dysfunction, and 0.7% (95% CI, 0.3%-1.1%) had severe diastolic dysfunction with 5.6% (95% CI, 4.5%-6.7%) of the population having moderate or severe diastolic dysfunction with normal EF. The prevalence of any systolic dysfunction (EF ≤50%) was 6.0% (95% CI, 5.0%-7.1%) with moderate or severe systolic dysfunction (EF ≤40%) being present in 2.0% (95% CI, 1.4%-2.5%). CHF was much more common among those with systolic or diastolic dysfunction than in those with normal ventricular function. However, even among those with moderate or severe diastolic or systolic dysfunction, less than half had recognized CHF. In multivariate analysis, controlling for age, sex, and EF, mild diastolic dysfunction (hazard ratio, 8.31 [95% CI, 3.00-23.1],P Conclusions In the community, systolic dysfunction is frequently present in individuals without recognized CHF. Furthermore, diastolic dysfunction as rigorously defined by comprehensive Doppler techniques is common, often not accompanied by recognized CHF, and associated with marked increases in all-cause mortality.
2,822 citations
TL;DR: Data from the Framingham Heart Study indicate that the incidence of congestive heart failure increases with age and is higher in men than in women, and diabetes mellitus and electrocardiographic left ventricular hypertrophy are also associated with an increased risk of heart failure.
2,249 citations
TL;DR: The aim of this paper is to review the clinical epidemiology of heart failure and to suggest a number of avenues for further research into the causes and treatments for heart failure.
Abstract: The aim of this paper is to review the clinical epidemiology of heart failure. The last paper comprehensively addressing the epidemiology of heart failure in Heart appeared in 2000. Despite an increase in manuscripts describing epidemiological aspects of heart failure since the 1990s, additional information is still needed, as indicated by various editorials.
1,657 citations
TL;DR: Prevalence and incidence rates of heart failure are high in individuals aged 55, almost 1 in 3 will develop heart failure during their remaining lifespan, and lifetime risk and prognosis are poor.
Abstract: Aims To determine the prevalence, incidence rate, lifetime risk and prognosis of heart failure.
Methods and Results The Rotterdam Study is a prospective population-based cohort study in 7983 participants aged ⩾55. Heart failure was defined according to criteria of the European Society of Cardiology. Prevalence was higher in men and increased with age from 0.9% in subjects aged 55–64 to 17.4% in those aged ⩾85. Incidence rate of heart failure was 14.4/1000 person-years (95% CI 13.4–15.5) and was higher in men (17.6/1000 man-years, 95% CI 15.8–19.5) than in women (12.5/1000 woman-years, 95% CI 11.3–13.8). Incidence rate increased with age from 1.4/1000 person-years in those aged 55–59 to 47.4/1000 person-years in those aged ⩾90. Lifetime risk was 33% for men and 29% for women at the age of 55. Survival after incident heart failure was 86% at 30 days, 63% at 1 year, 51% at 2 years and 35% at 5 years of follow-up.
Conclusion Prevalence and incidence rates of heart failure are high. In individuals aged 55, almost 1 in 3 will develop heart failure during their remaining lifespan. Heart failure continues to be a fatal disease, with only 35% surviving 5 years after the first diagnosis.
1,067 citations