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.

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

“…The prevalence of heart failure (1–2%) is consistent with several European focused cohort studies conducted over the past two decades 16. However, as recently highlighted, heart failure often goes undiagnosed, and thus its prevalence could be as high as 4% 16.…”

“…The overall distribution of heart failure with reduced (39%), mildly reduced (19%) and preserved (42%) left ventricular ejection fraction (HFrEF, HFmrEF and HFpEF, respectively) in routine clinical practice differs from other studies with highly selected populations in terms of HFrEF (56–60%) and HFpEF (16–23%),20 21 but is consistent with reports of increasing proportions of HFpEF in ageing populations 1 16. For instance, HFrEF is often reported to be more common in populations with acute heart failure 22.…”

“…The prevalence of heart failure (1-2%) is consistent with several European focused cohort studies conducted over the past two decades. 16 However, as recently highlighted, heart failure often goes undiagnosed, and thus its prevalence could be as high as Heart failure and cardiomyopathies 4%. 16 By applying a broader definition of heart failure, it can be expected that not only a higher prevalence would be estimated than that using the strict definition, but also increased discrepancy between countries.…”

“…16 However, as recently highlighted, heart failure often goes undiagnosed, and thus its prevalence could be as high as Heart failure and cardiomyopathies 4%. 16 By applying a broader definition of heart failure, it can be expected that not only a higher prevalence would be estimated than that using the strict definition, but also increased discrepancy between countries. The recent European Heart Failure Atlas Survey also found variations in prevalence between countries (1.2-3.9%), 16 potentially due to varying reporting practices and diagnostic tools, variation in the population's average age and, perhaps more importantly, differences in the clusters of risk factors.…”

Association between handgrip strength and heart failure in adults aged 45 years and older from NHANES 2011–2014

“…Currently, the incidence of HF in Europe is about 3/1000 person-years (all age groups) or about 5/1000 person-years in adults, the increase in overall incidence is mainly associated with people over 85, with a limited contribution from people under 55 1 , 2 . At the same time, data from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) showed an overall HF prevalence of 17 cases per 1000 people, the prevalence is approximately 1% for those aged < 55 years and > 10% for those aged 70 years or older 1 , 3 . In the United States, HF currently affects 6 million people, and the direct costs of HF treatment are expected to cost up to $30.7 billion and will double by 2030 4 , 5 .…”