Impact analysis of heart failure across European countries: an ESC-HFA position paper

Abstract

Heart failure (HF) is a long-term clinical syndrome, with increasing prevalence and considerable healthcare costs that are further expected to increase dramatically. Despite significant advances in therapy and prevention, mortality and morbidity remain high and quality of life poor. Epidemiological data, that is, prevalence, incidence, mortality, and morbidity, show geographical variations across the European countries, depending on differences in aetiology, clinical characteristics, and treatment. However, data on the prevalence of the disease are scarce, as are those on quality of life. For these reasons, the ESC-HFA has developed a position paper to comprehensively assess our understanding of the burden of HF in Europe, in order to guide future policies for this syndrome. This manuscript will discuss the available epidemiological data on HF prevalence, outcomes, and human costs-in terms of quality of life-in European countries.

Keywords: Epidemiology; Heart failure; Impact; Morbidity; Mortality; Prognosis; Quality of life.

Figure 1

Incidence of heart failure per 1000 person‐years (left) and prevalence of heart failure per 1000 persons (right). Adapted from Seferović et al.

Figure 2

Hazard ratios (HRs) for heart failure with mid‐range ejection fraction (HFmrEF) vs. heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) vs. HFpEF for all‐cause mortality up to 30 days (A), 1 year (B), and 3 years (C) for the overall cohort and for patients with and without coronary artery disease (CAD) separately. CI, confidence interval. *Adjusted for index year, age, gender, heart rate, estimated glomerular filtration rate, systolic blood pressure, diabetes, CAD, atrial fibrillation, valve disease, lung disease, anaemia, use of angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker, beta‐blocker, diuretic, statin, registration type, living arrangement, and education. From Koh et al.

Figure 3

Number of heart failure‐related hospital discharges per million people (left) and average length of stay in hospital primarily due to heart failure (right). Adapted from Seferović et al.

Figure 4

Classification of acute heart failure patients by geographical area (ESC‐HF‐LT registry). (A) Clinical profile classification by geographical area. (B) Systolic blood pressure (SBP) classification by geographical area. (C) Congestion/hypoperfusion classification by geographical area. ACS‐HF, acute heart failure and associated acute coronary syndrome; CS, cardiogenic shock; DHF, decompensated heart failure; HT‐HF, hypertensive heart failure; PO, pulmonary oedema; RHF, right heart failure. Eastern Europe = Bulgaria, Czech Republic, Hungary, Poland, Romania, Russian Federation, Slovakia, and Republics of Belarus, Moldova, and Ukraine. Northern Europe = UK, Sweden, Denmark, Finland, Norway, Ireland, Lithuania, Latvia, Estonia, Iceland, Channel Islands, Isle of Man, and Faeroe Islands. Southern Europe = Italy, Spain, Greece, Portugal, Serbia, Croatia, Bosnia and Herzegovina, Albania, North Macedonia, Slovenia, Montenegro, Malta, Andorra, Gibraltar, San Marino, and Holy See. Western Europe = Germany, France, the Netherlands, Belgium, Austria, Switzerland, Luxembourg, Monaco, and Liechtenstein. From Chioncel et al.