Real world heart failure epidemiology and outcome: A population-based analysis of 88,195 patients

Abstract

BackgroundHeart failure (HF) is frequent and its prevalence is increasing. We aimed to evaluate the epidemiologic features of HF patients, the 1-year follow-up outcomes and the independent predictors of those outcomes at a population level.Methods and resultsPopulation-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on December 31st, 2012. Patients were divided in 3 groups: patients without a previous HF hospitalization, patients with a remote (>1 year) HF hospitalization and patients with a recent (<1 year) HF admission. We analyzed 1year all-cause and HF hospitalizations, and all-cause mortality. Logistic regression was used to identify the independent predictors of each of those outcomes. A total of 88,195 patients were included. Mean age was 77 years, 55% were women. Comorbidities were frequent. Fourteen percent of patients had never been hospitalized, 71% had a remote HF hospitalization and 15% a recent hospitalization. At 1-year follow-up, all-cause and HF hospitalization were 53% and 8.8%, respectively. One-year all-cause mortality rate was 14%, and was higher in patients with a recent HF hospitalization (24%). The presence of diabetes mellitus, atrial fibrillation or chronic kidney disease was independently associated with all-cause and HF hospitalization and all-cause mortality. Hospital admissions and emergency department visits the previous year were also found to be independently associated with the three study outcomes.ConclusionsOutcomes are different depending on the HF population studied. Some comorbidity, an all-cause hospitalization or emergency department visit the previous year were associated with a worse outcome.

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“…In people, suffering from heart failure it is common that there is more than one myocardial abnormality present [1]. Heart failure is a complex health problem to manage, often with multiple underlying cardiac causes and comorbid with other chronic somatic diseases such as diabetes and chronic obstructive pulmonary disease [2,3]. This complexity is also mirrored in definitions of heart failure, especially when it comes to differentiating subtypes of heart failure.…”

“…In Sweden the estimated prevalence is 2.2% [3]. In a European perspective the mean age for persons with heart failure varies but is reported to be between 66 [7] and 79 years of age [2]. In Sweden, the mean age is 8o ± 12 years and 74 ± 13 years for women and men respectively [3].…”

“…In Sweden, the mean age is 8o ± 12 years and 74 ± 13 years for women and men respectively [3]. Heart failure is more common among men compared to women, with an exception for persons that have never been admitted to hospital for their heart failure and for those of the highest age [2,3,7]. Mortality rates vary considerably depending on whether the person has been recently hospitalised for heart failure or not.…”

“…Persons managed as ambulatory patients have a one-year mortality rate of 7-13%. Persons recently hospitalised due to heart failure have a one-year mortality rate of 17-24% [2,7] and the five-year survival rate in Sweden is 48% [3]. To compare, heart failure has higher mortality rates than common forms of cancer, such as prostatic cancer and breast cancer [8].…”

“…Persons with heart failure demonstrate an unpredictable health trajectory with one-year readmission to hospital rates reported to be between 31% [2] and 44% [7] and visits to hospital emergency departments being common (53% during a one-year period) [2]. For the northern European countries, Denmark, Norway and Sweden, the one-year hospitalisation rate is approximately 50% for persons recently hospitalised and 38% for persons managed as ambulatory patients [7].…”