Epidemiology of heart failure in Germany: a retrospective database study

Abstract

Background: Chronic heart failure (HF) is associated with significant healthcare expenditure, morbidity, and mortality. This study investigated the epidemiology of HF in Germany.

Methods: This retrospective study used anonymous healthcare claims data from the German Health Risk Institute on individuals with statutory health insurance. Patients with uninterrupted data from 1 January 2009 to 31 December 2013 or death (whichever occurred first), and ≥2 recorded HF-related diagnoses in 2011, were included. Patients with newly diagnosed HF were identified. Patients were followed up for 2 years from first diagnosis.

Results: Of 3,132,337 eligible patients, 123,925 (55.0% women; mean age 76.2 years) had HF: a prevalence of 3.96%. Of these, 26,368 had newly diagnosed HF: an incidence of 655/100,000 persons at risk. Incidence increased with age and was similar regardless of sex. During follow-up, there were 48,159 hospital admissions among newly diagnosed patients (1.8 hospitalizations/patient/2 years); HF accounted for 6% of these. Additionally, 20,148 patients (16.3%) overall and 5983 newly diagnosed patients (22.7%) died. Most new cases of HF were diagnosed by office-based physicians (63.2%); new cases among hospital inpatients were predominantly diagnosed by internal medicine specialists (70.7%). Overall, 94.0% received their initial prescription for HF treatment from a family practitioner.

Conclusions: The high prevalence and incidence observed in this representative sample emphasize the burden of HF in Germany. Substantial hospitalization rates and mortality highlight the need for early diagnosis and appropriate treatment, and for close cooperation between physician specialties and healthcare sectors.

Keywords: Epidemiology; Germany; Heart failure; Incidence; Prevalence.

Fig. 1

Prevalence of heart failure diagnoses by age group for a the total population with heart failure, and b the population according to specified NYHA classification. NYHA New York Heart Association

Fig. 2

Odds ratios showing the effect of age on the risk of hospitalization in patients with heart failure, estimated using a logistic regression model adjusted for treatment, dose used, duration of treatment, sex, comorbidities, and Charlson comorbidity index. Error bars show 95% confidence intervals. *p < 0.0001

Fig. 3

Odds ratios showing the effect of age on the risk of death in patients with heart failure, estimated using a logistic regression model adjusted for treatment, dose used, duration of treatment, sex, comorbidities, and Charlson comorbidity index. Error bars show 95% confidence intervals. *p < 0.0001

Fig. 4

Survival rate among patients with newly diagnosed heart failure in 2011, over the 2-year follow-up period. Q quarter

Fig. 5

Proportion of patients with newly diagnosed heart failure with a NYHA classification who died within the 2-year follow-up period. The numbers of patients with the NYHA classification who died divided by the total number of patients with that NYHA classification are shown. NYHA New York Heart Association