Over recent decades, the prevalence of heart failure has been on the increase in developed countries. Firstly, the number of elderly people in whom the problem is more common has increased, and secondly the number of people surviving acute myocardial infarction and high blood pressure the two main causes of heart failure is now greater due to improvements in treatment. This greater survival means patients eventually develop heart failure a common feature of many cardiac diseases , which is therefore seen to be more common.
In some ways, heart failure is the result of the chronic phase of acute myocardial infarctions or the complications of hypertensive heart disease owed to advances--but not cure--in medicine. Finally, there is evidence that the best heart failure treatments mainly angiotensin converting enzyme inhibitors [ACE inhibitors] and beta-blockers are beginning to increase survival rates.
Heart failure prevalence data can be complemented by the number of hospital admissions due to the disease--a figure that provides an idea of the associated healthcare burden. This information is interesting for several reasons. Firstly, the majority of countries keep systematic records on both private and public hospital admissions, and data are usually available at the national level. It is therefore a relatively cheap way of monitoring the problem. Secondly, the majority of healthcare costs associated with heart failure are generated by hospitalization. Thirdly, in its advanced stages, heart failure leads to repeated hospitalization.
Nevertheless, it should be remembered that while the number of hospitalizations may provide adequate information on the healthcare burden, it does not necessarily do so with respect to the frequency of heart failure. The majority of health information systems do not provide data on the number of patients per se , but on the number of hospitalizations in a more administrative sense, i. Further, the number of hospitalizations does not depend on the frequency of heart failure alone, but also on the availability of hospital beds and the admission policies of each hospital or health system.
Geographical variability with respect to the number of hospital admissions for heart failure in Spain is in part due to the differences in hospital resources between provinces. Some 80 hospital admissions for heart disease occur every year in Spain Figure 1. As in other developed countries, heart failure is the number one cause of hospitalization in people over 65 years of age, followed by heart disease and ictus.
A: number of hospital discharges of patients admitted with heart failure. B: admissions due to heart failure as a percentage of all-cause admissions in Spain Code of ICD-9 for the entire study period.. Incidence measures the number of new cases of a disease over a given time period and provides information on the importance of the different risk factors in the general population. To measure disease incidence, people who are originally free of disease need to be monitored over the set time period and the number of new cases recorded.
These studies are more informative when they are population-based and record both intrahospital and extrahospital cases. The most detailed data available on the incidence of heart failure are those provided by the Framingham study. It is twice as high among hypertensive than normotensive subjects, and five times greater among those who have suffered a myocardial infarction than among those who have not.
There have been very few studies that have recorded changes in the incidence of heart failure, mainly because a standard measuring system needs to be used over the entire period examined. In this respect, the Framingham study is again that which provides the best data. The incidence of heart disease has been stable among men since the s, whereas in women it has dropped the main reduction occurring during the s.
These results are surprising when it is remembered that the control of high blood pressure, one of the main causes of heart failure, has improved through the generalization of treatment. However, it can also be argued that this has prevented many coronary and cerebrovascular deaths and has increased the number of people who survive and remain at risk of developing heart failure. The reduction in the incidence of ischemic heart disease in some areas should also have reduced the incidence of heart failure. But again, this could be balanced out by the increased survival of ischemic heart disease patients who go on to develop heart failure.
Finally, there is an epidemic of obesity and type 2 diabetes in the developed world, both of which are important risk factors for heart failure.. Heart failure is a progressive, lethal disease, even when adequately treated. Survival is determined by the follow-up of heart failure patients included in control groups in clinical trials, and by examining hospital records or the results of cohort studies involving the general population. Normally, the survival of patients included in clinical trials is better than that seen in population-based studies since the former tend to include younger patients with fewer accompanying ailments.
The Framingham study also provides some of the best data on survival in heart failure patients. Relatively few studies have been published on changes in survival among patients with heart failure in recent decades. Nonetheless, evidence from community-based 16 studies and investigations performed at medical centers 21,22 suggests that survival has improved over the last 10 years.
This improvement coincides with the increased use of therapies such as the use ACE inhibitors and beta-blockers that in clinical trials have been shown to reduce the mortality associated with heart failure. Paradoxically, this desirable improvement in survival also translates into greater numbers of people with heart failure, increasing the social burden..
This improvement in prognosis for people with heart failure is, however, smaller than that desired. The reasons for this are several. Firstly, heart failure is a syndrome with multiple causes.
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Many patients show preserved systolic function but have ventricular filling or valve problems, and neither ACE inhibitors nor beta-blockers appear to help them. Secondly, many patients with heart failure are women, are elderly, or have important comorbidity, and these groups have not normally been included in clinical trials. Finally, the clinical treatment of heart failure patients with low ejection fractions is sub-optimal, although recently it seems to have improved. The mortality associated with heart failure is calculated from death certificate data as incorporated into national vital statistics.
Apart from hospital admissions, it is the only indicator that provides mortality data at the national level. Mortality figures provide information on the demographic impact of heart failure, although they usually underestimate its magnitude since the norms for coding cardiovascular death in national vital statistics prioritize ischemic heart disease ahead of heart failure..
Heart failure is the third most common cause of cardiovascular death in Spain, after ischemic heart disease and cerebrovascular disease. Heart failure mortality increases from northern Spain towards the south and the Mediterranean regions, and shows a similar pattern to the mortality associated with ischemic heart disease and cerebrovascular disease. It is also similar to that of angina prevalence. Also among women, heart failure has become more important as a cause of death within the cardiovascular disease group Figure 2B.
As with the number of hospitalizations, the number of deaths due to heart failure is greater among women than among men.. A: number of deaths due to heart failure. B: deaths due to heart failure as a percentage of all cardiovascular deaths in Spain The decreasing tendencies observed in Spain with respect to death due to heart failure are consistent with results from Canada, the USA, 29 and Argentina. Nearly all the above data correspond to "total" heart failure, i. Because of selection criteria, clinical studies show heart failure with reduced systolic function to be more commonly recorded at cardiology departments than at internal medicine or geriatric departments.
The epidemiology and natural history of heart failure with diastolic dysfunction are poorly understood because of the difficulty in confirming this diagnosis with the procedures used in epidemiological studies. For this reason, these patients have not been included in the majority of clinical trials. The treatment criteria for this problem are therefore based on less scientific evidence than those for heart failure with reduced ejection fraction.
Until recently it was believed that diastolic heart failure had a better prognosis than systolic heart failure, 24,32 especially in older patients, 33 but recent evidence suggests that their long term prognosis is similar. However, several studies increase this range to 0. The prevalence, incidence and mortality of heart failure are actually somewhat higher among men than women. However, since these three indicators increase greatly with age, and since there are more elderly women than elderly men, the total number of cases and deaths caused by heart failure is greater among women..
After adjustment for age, the survival of women with heart failure is greater than that of men. However, heart failure with conserved systolic function is more frequent in women, and therefore many studies may have recorded a higher number of false positives among them, i. Compared to men, women with heart failure usually show more symptoms for similar ejection fractions, 40 are older, more commonly suffer diabetes mellitus and high blood pressure, and less frequently suffer ischemic heart disease.
For example, it would appear that digoxin treatment increases mortality among women with heart failure and LVSD--something not seen among male patients. As mentioned earlier, the main precursors of heart failure are coronary heart disease and high blood pressure which often appear together , followed by myocardial disease and valve dysfunction. Heart failure due to acute myocardial infarction is accompanied by systolic ventricular dysfunction more often than when due to high blood pressure.
In the Anglo-Saxon world, coronary heart disease has increased in importance over recent decades as a cause of heart failure, while the importance of high blood pressure has shown a relative decline.
The main risk factors for heart failure diabetes, smoking, dyslipidemia, obesity and a sedentary lifestyle 15,42 are also those of its precursor conditions. Recent evidence suggests that higher homocysteine levels, 43 pulse pressure 44 , and some plasma markers of inflammation interleukin 6, C-reactive protein, tumor necrosis factor alpha 45 are associated with an increased risk of heart failure, whereas moderate alcohol consumption is associated with a decreased risk. The idea of opportunistic screening of the population for heart failure and ventricular dysfunction during medical contact with elderly patients has been suggested: the prevalence of heart failure is high among older people, there are effective treatments that can improve the quality of life and reduce the number of hospitalizations and mortality associated with the problem, and the earlier treatment begins the better the prognosis.
Similar screening is performed for certain tumors. This type of screening would be more efficient more cases of heart failure detected per persons examined if it were aimed at those patients at greatest risk, such as those with high blood pressure, diabetes, and those with a history of ischemic heart disease or other heart problems.
Patients could also be selected according to the results of heart failure risk equations such as those used in the Framingham study. These estimate the risk of heart failure by considering age, left ventricular hypertrophy, heart rate, systolic blood pressure, whether the patient has diabetes mellitus, and evidence of previous myocardial infarction, valve disease or high blood pressure. More precise estimations can be made if vital capacity and the possibility of cardiomegaly, judged from a recent chest X-ray, 47 are taken into account. People at greater risk are more likely to have left ventricular dysfunction; in these patients, the diagnostic efficiency of echocardiography is greater..
Community screening for LVSD is, however, a premature course of action. Echocardiography would be very expensive and impractical on a large scale, and the diagnostic validity of natriuretic peptides is less than perfect. Secondly, looking for LVSD would leave out a large number of people who might develop heart failure but maintain normal systolic function. Finally, the bulk of the evidence concerning the risk of developing heart failure with LVSD comes from clinical trials in which many of the patient types at greatest risk were not included..
In the developed world, the increased prevalence of heart failure over recent decades and the number of hospitalizations associated with this syndrome, have led to its recognition as a 21st century cardiovascular epidemic. Demographic projections suggest that this problem will continue to increase among people over 65 years of age in the coming years.
Given the frequency of heart failure in these older people, only a large reduction in the incidence of the disease, or a non-desirable reduction in survival, can stop the number of people suffering heart failure from increasing. The literature suggests that survival associated with the syndrome is improving, but that there is no appreciable reduction in its incidence. The control of risk factors such as high blood pressure and ischemic heart disease the main causes of heart failure in Spain is the only way to attenuate the foreseeable increase in the frequency of this disease in the near future.
Section sponsored by the Dr. Esteve Laboratory. Correspondence: Dr. Facultad de Medicina. E-mail: fernando.
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Their Nature Incidence and Care
As in other developed countries, it is the most common cause of hospitalization among persons 65 years of age and over. Heart failure is a progressive, lethal disorder, even with adequate treatment. In Spain, heart failure is the third leading cause of cardiovascular mortality, after coronary heart disease and stroke. In recent decades, the prevalence and number of hospitalizations due to heart failure have increased steadily in developed countries. Heart failure will probably continue to increase in frequency in the coming years since there has been no appreciable reduction in its incidence.
However, survival is increasing due to better treatment. The control of risk factors for hypertension and ischemic heart disease, the main causes of heart failure in Spain, is the only way to halt the foreseeable increase in the frequency of heart failure in the near future..
Epidemiology of Heart Failure | Revista Española de Cardiología (English Edition)
Palabras clave:. The remaining data of epidemiological interest have been extrapolated from the international mainly Anglo-Saxon literature. This is to be expected, not just because of the increased frequency of the problem but also because heart failure is less symptomatic in younger people.
Eur Heart J, 18 , pp. Canberra: AIHW; Get citations as an Endnote file : Endnote. PDF Report Kb. View other formats. Chronic respiratory diseases, such as asthma and emphysema, are very prevalent in Australia. They disrupt the daily life and productivity of many individuals and lead to thousands of deaths each year. Many of these diseases are largely preventable and manageable.
This report brings together data from a variety of sources to highlight the prevalence and impact of chronic respiratory diseases in Australia. The information included in this report will be relevant to policy makers, the broader community and anyone with an interest in the respiratory diseases. Chronic respiratory diseases are a diverse group of conditions affecting the lungs or respiratory tract for a prolonged period.
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They are often incurable, but are largely manageable and preventable. Chronic respiratory diseases are very prevalent in Australia-an estimated 5. Each year, chronic respiratory diseases disrupt the daily life and productivity of many individuals and contribute to thousands of deaths. Two major chronic respiratory diseases in Australia are chronic obstructive pulmonary disease COPD and asthma.
The death rate, however, is declining, especially among males. Although it is not a major cause of death, asthma is one of the most common problems managed by doctors and is a frequent reason for the hospitalisation of children, especially boys. Other chronic respiratory diseases, such as hay fever and chronic sinusitis, are noteworthy for being highly prevalent. For example, in about 2 million Australians were estimated to have chronic sinusitis. Other diseases, such as bronchiectasis and pneumoconiosis, have potentially serious consequences for the comparatively few people they afflict.
Their high prevalence and potentially severe consequences notwithstanding, chronic respiratory diseases are largely preventable. Much is known about their causes and risk factors, some of which can be addressed through public health interventions. Major goals of chronic respiratory disease prevention and control include avoiding commencement of smoking, early detection of disease in at-risk groups, improving rates of smoking cessation, management of stable disease and prevention of exacerbations.
By far the most important cause of COPD is tobacco smoking. Smoking also worsens the symptoms and control of asthma and other chronic respiratory diseases. Recent surveys show that over the past decade the proportion of current smokers in Australia has decreased, while the proportion of those who have never smoked has risen.
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