Those with condition also at high risk of death and additional serious complications

High prevalence, linked health risks, and costs warrant urgent action, say researchers

Up to 2% of adults in Europe, North America, and Israel likely have heart failure, and are at high risk of death and additional serious complications, suggest current estimates based on digital health records for 11 countries, and published online in the journal Heart.

The high prevalence of the condition, associated health risks, including coronary artery disease and chronic kidney failure, and costs—human and fiscal—warrant urgent action, say the researchers.

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 also expensive, with Europe and the US each allocating 1–2% of their annual healthcare budgets towards treating it.

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, have drawn on highly selected patient groups, meaning that the findings are unlikely to be generally representative, say the researchers.

To overcome this, they designed the CardioRenal and Metabolic disease (CaReMe) heart failure study to estimate the prevalence, key unfavourable outcomes, and costs of the condition for 11 countries.

These were: Sweden, Norway, the UK, Belgium, Germany, Switzerland, Italy, Spain, Portugal, Israel and Canada.

The researchers summarised 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. 

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 ischaemic 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 (49%) had moderate to severe chronic kidney disease. 

Episodes of illness were cumulatively reported per 100 patient years—in other words, the percentage of patients who had an annual episode—and cumulative costs of hospital care calculated for each person for up to 5 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 further worsening of heart failure and kidney function, say the researchers.   

The costs of hospital care—available for 6 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.

This is 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 3 of the 11 countries, nor was it possible to account for unreported and undiagnosed heart failure. And the study only focused on outcomes requiring hospital care, they add.

But their findings indicate the need for urgent action, they say. “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 prioritise when planning healthcare for patients with [heart failure],” they conclude.


Research: Prevalence, outcomes and costs of a contemporary, multinational population with heart failure doi 10.1136/heartjnl-2022-321702

Journal: Heart

Funding: AstraZeneca

Link to Academy of Medical Sciences press release labelling system

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People