More people are at risk of heart failure worldwide, researchers say

Science and Health

Up to two percent of adults in Europe, North America and Israel are likely have heart failure, which carries a high risk of additional serious complications and death. This high prevalence, linked health risks and costs warrant urgent action, said researchers in the Academy of Medical Sciences.

The new estimates were based on digital health records for 11 countries and just published online in the journal Heart under the title “Prevalence, outcomes and costs of a contemporary, multinational population with heart failure.”Heart failure occurs when the heart can’t pump blood around the body properly. It usually happens because the heart has become too weak or stiff. It doesn’t mean that the heart has stopped working but that it needs support to help it work better. Heart failure can occur at any age, but it is most common in older people and is a chronic condition that tends to get worse.The high prevalence of the condition, associated health risks including coronary artery disease and chronic kidney failure and costs, both human and financial, warrant urgent action, the researchers warned. Heart failure affects millions of people around the globe, but the number of cases is expected to rise as populations age and diagnosis improves, they point out. It’s expensive, with Europe and the US each allocating one to two percent of their annual healthcare budgets for treating it.

The Olga and Lev Leviev Heart Center at Sheba Medical Center is one of Israel’s leading cardiology departments, according to Forbes Israel (credit: MIRIAM ALSTER/FLASH90)

Few studies have used both digital medical records and national registry data to assess the impact of heart failure in the round – and those that have were based on highly selected patient groups, meaning that the findings are unlikely to be generally representative.To overcome this, they designed the CardioRenal and Metabolic disease (CaReMe) heart failure study to estimate the prevalence, key unfavorable outcomes, and costs of the condition for 11 countries – Sweden, Norway, the UK, Belgium, Germany, Switzerland, Italy, Spain, Portugal, Israel and Canada.The researchers summarized and pooled the individual healthcare systems data for more than 600,000 people with diagnosed heart failure in the participating countries between 2018 and 2020.

What’s the difference between heart failure and general heart problems?

HEART FAILURE was broadly defined as any registered heart failure diagnosis, and strictly defined as requiring admission to hospital for the condition. The average age of patients, using the broad definition, was 75; 45% were women.

Some 42% of patients with heart failure had preserved left ventricular ejection fraction, which occurs when the lower left chamber of the heart (left ventricle) isn’t able to fill properly with blood (diastolic phase), so reducing the amount of blood pumped back out into the body.Nearly half (49%) the patients with heart failure had ischemic heart disease; 44% had irregular heart rhythm (atrial fibrillation); and just over a third (34.5%) had diabetes. Among the 170,000 people with heart failure whose kidney function was measured, half had moderate-to-severe chronic kidney disease.Episodes of illness were cumulatively reported per 100 patient years, meaning that the percentage of patients who had an annual episode and cumulative costs of hospital care calculated for each person for up to five years.Based on the data, the researchers estimated that the prevalence of heart failure among adults was 2% when applying the broad definition and 1% when applying the strict definition across all 11 countries and more than 32 million people.The highest prevalence (broad definition) was in Portugal (just under 3%); the lowest was in the UK (almost 1.5%).Risks of annual hospital admission were highest for those with heart failure and chronic kidney disease (19%) and lower for those with other cardiovascular disease, such as heart attack (3%), stroke (2%), and peripheral artery disease (1%). The annual death rate was 13%.These figures indicate that preventive treatment should primarily focus on stopping worsening of heart failure and kidney function, said the researchers, among whom was cardiologist Dr. Anna Norhammar of the Karolinska University Hospital in Stockholm, Sweden.The costs of hospital care, which was available for six countries and 462,825 patients, were highest for those with both heart and kidney disease and higher than those stemming from coronary artery disease and stroke.It was an observational study, and the researchers highlight several limitations to their findings, including that they may not be applicable to other races or people with different resources or access to healthcare. The prevalence of heart failure wasn’t available for three of the 11 countries nor was it possible to account for unreported and undiagnosed heart failure. And the study focused only on outcomes requiring hospital care.But their findings underlined the need for urgent action. “The cardiorenal burden, risks and costs in heart-failure patients highlights an urgent need for improved risk management and an area that policy-makers need to prioritize when planning healthcare for patients with the disease, they concluded.