Prevalence, outcomes and costs of a contemporary, multinational population with heart failure

Abstract

Objective: Digital healthcare systems could provide insights into the global prevalence of heart failure (HF). We designed the CardioRenal and Metabolic disease (CaReMe) HF study to estimate the prevalence, key clinical adverse outcomes and costs of HF across 11 countries.

Methods: Individual level data from a contemporary cohort of 6 29 624 patients with diagnosed HF was obtained from digital healthcare systems in participating countries using a prespecified, common study plan, and summarised using a random effects meta-analysis. A broad definition of HF (any registered HF diagnosis) and a strict definition (history of hospitalisation for HF) were used. Event rates were reported per 100 patient years. Cumulative hospital care costs per patient were calculated for a period of up to 5 years.

Results: The prevalence of HF was 2.01% (95% CI 1.65 to 2.36) and 1.05% (0.85 to 1.25) according to the broad and strict definitions, respectively. In patients with HF (broad definition), mean age was 75.2 years (95% CI 74.0 to 76.4), 48.8% (40.9-56.8%) had ischaemic heart disease and 34.5% (29.4-39.6%) had diabetes. In 51 442 patients with a recorded ejection fraction (EF), 39.1% (30.3-47.8%) had a reduced, 18.8% (13.5-24.0%) had a mildly reduced and 42.1% (31.5-52.8%) had a preserved left ventricular EF. In 1 69 518 patients with recorded estimated glomerular filtration rate, 49% had chronic kidney disease (CKD) stages III-V. Event rates were highest for cardiorenal disease (HF or CKD) and all cause mortality (19.3 (95% CI 11.3 to 27.1) and 13.1 (11.1 to 15.1), respectively), and lower for myocardial infarction, stroke and peripheral artery disease. Hospital care costs were highest for cardiorenal diseases.

Conclusions: We estimate that 1-2% of the contemporary adult population has HF. These individuals are at significant risk of adverse outcomes and associated costs, predominantly driven by hospitalisations for HF or CKD. There is considerable public health potential in understanding the contemporary burden of HF and the importance of optimising its management.

Keywords: Epidemiology; Heart Failure.

Figure 1

Number of included patients with heart failure (HF) in each of the 11 participating countries.

Figure 2

Description of data sources used across the participating countries. Data extractions are from the following levels of healthcare: (1) primary healthcare, (2) secondary healthcare (specialist or outpatient hospital care) and (3) tertiary healthcare (inhospital care). Green colour, Data available and utilized; Orange colour, Data not available.

Figure 3

Baseline measurements of left ventricular ejection fraction (n=51 422) and estimated glomerular filtration rate (eGFR, n=1 69 518) across participating countries from data sources including these variables. (A) The proportion of 51 442 patients with heart failure and reduced (HFrEF), mildly reduced (HFmrEF) and preserved (HFpEF) left ventricular ejection fraction. Mean (SD) ejection fraction (EF%) is shown for each country on top of each bar. (B) The 1 69 518 patients with heart failure and a recorded eGFR value. Mean (SD) eGFR is shown for each country on top of each bar. Chronic kidney disease defined as eGFR <60 mL/min/1.73 m².

Figure 4

Cumulative hospital healthcare costs per patient in 3 62 825 patients with heart failure (HF) from six countries. Hospital healthcare cost data were available from Canada, Italy, Portugal, Spain, Sweden and the UK. Costs are in US$ per patient at index and cumulatively over a period of up to 5 years (from 2014 in Sweden, the UK and Canada; from 2015 in Spain; from 2017 in Portugal; and from 2018 in Italy). The x axis is the number of years (year 0 to 1 almost not illustrated). *For the purpose of currency conversion to US Dollars, US$1=0.77 Canadian Dollars, 1.13 Euros and 8.56 Swedish Krona. Fixed currency rates were used and variations over time were not accounted for. CKD, chronic kidney disease; MI, myocardial infarction; PAD, peripheral artery disease.