Higher prevalence of heart failure in rural regions: a population-based study covering 87% of German inhabitants

Holstiege, Jakob; Akmatov, Manas K.; Störk, Stefan; Steffen, Annika; Bätzing, Jörg

doi:10.1007/s00392-019-01444-8

Cited by 14 publications

(7 citation statements)

References 17 publications

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“…Additionally, the complexity of HF diagnosis and different pathobiological mechanisms may lead to diverse presentation pictures. Notably, differences between studies results might be related to different medical practice and to varying densities of HF units and hospitals in different countries, and even in different regions within one country might affect mortality 2 , 34 , 35 ( Figure 2 ).…”

Section: In‐hospital Treatment Of Patients With Acute Worsening Of Heart Failurementioning

confidence: 99%

‘Time is prognosis’ in heart failure: time‐to‐treatment initiation as a modifiable risk factor

et al. 2021

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In heart failure (HF), acute decompensation can occur quickly and unexpectedly because of worsening of chronic HF or to new‐onset HF diagnosed for the first time (‘de novo’). Patients presenting with acute HF (AHF) have a poor prognosis comparable with those with acute myocardial infarction, and any delay of treatment initiation is associated with worse outcomes. Recent HF guidelines and recommendations have highlighted the importance of a timely diagnosis and immediate treatment for patients presenting with AHF to decrease disease progression and improve prognosis. However, based on the available data, there is still uncertainty regarding the optimal ‘time‐to‐treatment’ effect in AHF. Furthermore, the immediate post‐worsening HF period plays an important role in clinical outcomes in HF patients after hospitalization and is known as the ‘vulnerable phase’ characterized by high risk of readmission and early death. Early and intensive treatment for HF patients in the ‘vulnerable phase’ might be associated with lower rates of early readmission and mortality. Additionally, in the chronic stable HF outpatient, treatments are often delayed or not initiated when symptoms are stable, ignoring the risk for adverse outcomes such as sudden death. Consequently, there is a dire need to better identify HF patients during hospitalization and after discharge and treating them adequately to improve their prognosis. HF is an urgent clinical scenario along all its stages and disease conditions. Therefore, time plays a significant role throughout the entire patient's journey. Therapy should be optimized as soon as possible, because this is beneficial regardless of severity or duration of HF. Time lavished before treatment initiation is recognized as important modifiable risk factor in HF.

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Section: In‐hospital Treatment Of Patients With Acute Worsening Of Heart Failurementioning

confidence: 99%

‘Time is prognosis’ in heart failure: time‐to‐treatment initiation as a modifiable risk factor

et al. 2021

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“…We thus aimed to determine the nation-wide age- and sex-stratified prevalence of PAD in Germany from 2009 to 2018 through ambulatory claims data for all statutorily insured patients in Germany. An estimated 87% of the total German population is statutorily insured; the remaining 13% of the population is insured privately [13] . Thus, claims data provide a global picture regarding treatment patterns.…”

Section: Introductionmentioning

confidence: 99%

Peripheral artery disease in Germany (2009–2018): Prevalence, frequency of specialized ambulatory care and use of guideline-recommended therapy – A population-based study

Rammos

Steinmetz

Lortz

et al. 2021

The Lancet Regional Health - Europe

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Background Peripheral artery disease (PAD) patients have high morbidity and mortality rates, demonstrating a need for improved treatment strategies. While underuse and undertreatment have been reported, there is no clear picture of patterns in population-level disease prevalence, prescription of guideline-recommended pharmacotherapy, or frequency of contact with dedicated specialists. We present population-level data on changes in prevalence, care and treatment of PAD from 2009 to 2018 in Germany. Methods We analyzed the ambulatory claims data for all statutorily insured patients comprising 70.1 million patients each year and 87% of the German population. Prevalence was assessed by documentation of PAD and stratified by age and sex within the 10-year study timeframe. In addition, current ambulatory care, stratified by vascular specialists (vascular surgeons or angiologists), internists, cardiologists and primary care physicians, were examined. Findings Prevalence increased from 1·85% in 2009 to 3·14% in 2018, affecting 2·3 million patients in 2018 and more males (55%) than females (45%). A low level of visits to vascular specialists, with 11·1% receiving care from vascular surgeons and 8·1% from angiologists, was shown. Moreover, analysis of guideline-recommended prescriptions revealed increasing, but still insufficient, prescription frequencies among PAD patients between 2009 and 2016, from 42·6% to 56% for statins and from 40·2% to 48·0% for antiplatelets. Interpretation Our results show that the prevalence of PAD in Germany, as assessed by outpatient PAD documentation, is increasing and PAD patients are underutilizing specialized vascular care; moreover, the prescription frequency of guideline-recommended therapies remains low. There is a clear need to improve the referral and treatment algorithms in the high-risk PAD population. Funding None.

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“…The prevalence of heart failure (HF) is estimated to be 3–4%, and it has an incidence of approximately 6 per 1000 persons per year [ 1 , 2 ]. Approximately 456,012 patients had to be hospitalized for HF in Germany in 2018 [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of noninvasive telemedical interventional management in patients with heart failure: health economic analysis of the TIM-HF2 trial

et al. 2021

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Background Noninvasive remote patient management (RPM) in patients with heart failure (HF) has been shown to reduce the days lost due to unplanned cardiovascular hospital admissions and all-cause mortality in the Telemedical Interventional Management in Heart Failure II trial (TIM-HF2). The health economic implications of these findings are the focus of the present analyses from the payer perspective. Methods and results A total of 1538 participants of the TIM-HF2 randomized controlled trial were assigned to the RPM and Usual Care group. Health claims data were available for 1450 patients (n = 715 RPM group, n = 735 Usual Care group), which represents 94.3% of the original TIM-HF2 patient population, were linked to primary data from the study documentation and evaluated in terms of the health care cost, total cost (accounting for intervention costs), costs per day alive and out of hospital (DAOH), and cost per quality-adjusted life year (QALY). The average health care costs per patient year amounted to € 14,412 (95% CI 13,284–15,539) in the RPM group and € 17,537 (95% CI 16,179–18,894) in the UC group. RPM led to cost savings of € 3125 per patient year (p = 0.001). After including the intervention costs, a cost saving of € 1758 per patient year remained (p = 0.048). Conclusion The additional noninvasive telemedical interventional management in patients with HF was cost-effective compared to standard care alone, since such intervention was associated with overall cost savings and superior clinical effectiveness. Graphical abstract

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Higher prevalence of heart failure in rural regions: a population-based study covering 87% of German inhabitants

Cited by 14 publications

References 17 publications

‘Time is prognosis’ in heart failure: time‐to‐treatment initiation as a modifiable risk factor

‘Time is prognosis’ in heart failure: time‐to‐treatment initiation as a modifiable risk factor

Peripheral artery disease in Germany (2009–2018): Prevalence, frequency of specialized ambulatory care and use of guideline-recommended therapy – A population-based study

Cost-effectiveness of noninvasive telemedical interventional management in patients with heart failure: health economic analysis of the TIM-HF2 trial

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