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. 2024 Jan 3;41(1):47-53.
doi: 10.4274/balkanmedj.galenos.2023.2023-10-5.

Exploring Regional Disparities in Heart Failure Epidemiology and Outcomes: A Comprehensive Study Across Geographical Regions in Türkiye

Anıl Şahin  1 , Tuğçe Çöllüoğlu  2 , Ahmet Çelik  3 , Naim Ata  4 , Mehmet Birhan Yılmaz  5 , Dilek Ural  6 , Arzu Kanık  7 , Mustafa Okan Ayvalı  4 , Mustafa Mahir Ülgü  4 , Şuayip Birinci  8
Affiliations

Exploring Regional Disparities in Heart Failure Epidemiology and Outcomes: A Comprehensive Study Across Geographical Regions in Türkiye

Anıl Şahin et al. Balkan Med J. .

Abstract

Background: Heart failure (HF) is a common condition that affects 1-3% of the general population. Its prevalence exhibits notable international and intranational disparities, partly explained by socioeconomic status, religion, ethnic diversity, and geographic factors. A comprehensive understanding of the epidemiological symptoms of HF in different regions of Türkiye has yet to be revealed.

Aims: To examine epidemiological data from 2016 to 2022, focusing on crucial patient characteristics and geographical regions, to determine the incidence and prevalence of HF in Türkiye across seven diverse geographical regions.

Study design: A nationwide population-based retrospective cohort study.

Methods: The comprehensive National Electronic Database of the Turkish Ministry of Health was used in this study to obtain data that covers the whole Turkish population from January 1, 2016, to December 31, 2022. The International Classification of Diseases-10 (ICD-10) codes were used to identify adults with HF (n = 2,701,099) and associated comorbidities. Türkiye is divided into seven geographically distinct regions. Epidemiological characteristics and survival data of these regions were analyzed separately. All-cause mortality was set as the primary outcome.

Results: In , the total estimated prevalence of adult patients with HF is 2.939%, ranging from 2.442% in Southeastern Anatolia to 4.382% in the Black Sea Region. Except for the Eastern Anatolia Region, the three most often reported comorbidities were hypertension, dyslipidemia, and anxiety disorders. The rates of prescribing guideline-directed medical therapy (GDMT) for HF and other medications varied significantly. GDMT prescription rates were lowest in the Eastern Anatolia Region (82.6% for beta-blockers, 48.7% for RASi, 31.8% for mineralocorticoid receptor antagonists, and 9.4% for SGLT2i). The Mediterranean and Aegean regions had the highest median N-terminal brain natriuretic peptide (NT-proBNP) levels of 1,990,0 pg/ml (518.0-6,636,0) and 1,441,0 pg/ml (363.0-5,000,0), respectively. From 2016 to 2022, 915,897 (33.9%) of 2,701,099 patients died. The Eastern Anatolia Region had the lowest all-cause mortality rate of 26.5%, whereas the Black Sea Region had the highest all-cause mortality rate of 35.3%.

Conclusion: Our real-world analysis revealed geographic disparities in HF characteristics, such as decreased mortality in socioeconomically challenged regions. Higher stress susceptibility in developed regions may increase the likelihood of adverse outcomes.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Distribution of heart failure prevalence by regions in Türkiye (per 1,000 person-years).
Figure 3
Figure 3
Incidence of patients with heart failure by geographic regions.
See this image and copyright information in PMC

References

    1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–1858. - PMC - PubMed
    1. Çavuşoğlu Y, Altay H, Aras D, et al. Cost-of-disease of Long COVID-19in : A Delphi Panel-based Analysis of Direct and Indirect Costs. Balkan Med J. 2022;39:282–289. - PMC - PubMed
    1. Savarese G, Becher PM, Lund LH, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118:3272–3287. - PubMed
    1. Andersen J, Gerds TA, Gislason G, et al. Socioeconomic position and one-year mortality risk among patients with heart failure: A nationwide register-based cohort study. Eur J Prev Cardiol. 2020;27:79–88. - PubMed
    1. No Authors. National Structures (Non-EU). Eurostat. 2016.