The current and future burden of heart failure in Portugal

Medicina clínica práctica, 2020

To analyze the epidemiological characteristics of heart failure (HF) and estimate the burden of the disease on the health service by means of real world data (RWD). Patients and methods: All patients discharged from any Basque Health Service hospital after a first admission for HF between 2011 and 2015. Data sources: Databases of our health service. Outcomes: 30-and 365-day admissions, potentially avoidable hospitalizations (PAHs), mortality. Statistical analysis: Descriptive statistics, age-standardized event rates. Results: The cohort was composed of 15,109 patients (mean age 79.8 ± 10.1 years). At discharge patients had a median of 8 chronic conditions. 36% of them had had hospitalizations and 83% had visited a specialist (42% of them a cardiologist) during the previous year. Mortality was 24.5% within 365 days after discharge. Within 30 days after discharge, there were 2608 unplanned admissions, 49% for non-cardiovascular disease (CVD), 36% for HF and 15% for a CVD other than HF. 34% were classified as PAH. In the first 365 days after discharge, there were 14,559 hospitalizations, 54% for non-CVD reasons, 32% for HF and 13% for a CVD other than HF. Overall, 35% were PAHs. Conclusion: (1) People admitted for HF are old, and they have multimorbidity and high rates of admissions due to non-CVD reasons and PAHs after discharge. These finding suggest the need of strengthening continuity of care and managing comorbidities. (2) Besides, most people admitted for HF have previous contacts with the Healthcare system, which suggests opportunities for prevention before disease worsening.

Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2018

Heart failure is a major public health problem that affects a large number of individuals and is associated with high mortality and morbidity. This study aims to estimate the probable scenario for HF prevalence and its consequences in the short-, medium- and long-term in Portugal. This assessment is based on the EPICA (Epidemiology of Heart Failure and Learning) project, which was designed to estimate the prevalence of chronic heart failure in mainland Portugal in 1998. Estimates of heart failure prevalence were performed for individuals aged over 25 years, distributed by age group and gender, based on data from the 2011 Census by Statistics Portugal. The expected demographic changes, particularly the marked aging of the population, mean that a large number of Portuguese will likely be affected by this syndrome. Assuming that current clinical practices are maintained, the prevalence of heart failure in mainland Portugal will increase by 30% by 2035 and by 33% by 2060, compared to 20...

Esc Heart Failure, 2022

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.

Revista Portuguesa de Cardiologia, 2016

Introduction and Objectives: Acute heart failure (AHF) is a heterogeneous clinical syndrome requiring urgent therapy. The prognosis is poor after the index hospitalization, with a high risk for rehospitalization and early death. The costs of managing AHF are thus increasing rapidly. A literature review was performed to gather and compare data on prevalence and treatment and to identify gaps in AHF management, based on European and Portuguese studies. Methods: A literature search from 1995 to 2014 was conducted in selected databases (BIOSIS Previews, EMBASE and Ovid MEDLINE). Results and Discussion: Seven Portuguese and nine European studies were analyzed. The mean age of AHF patients was ≥65 years and 30---50% were women. Coronary artery disease (42.3% vs. 61.9%) and hypertension (53.3% vs. 76.7%) were identified as primary etiologies in Europe and in Portugal. Similar proportions of heart failure with preserved ejection fraction were found in the Portuguese (19.9---44.7%) and European (32.8---39.1%) studies. Overall, all-cause mortality rates were comparable (six months: 9.3---25.5% vs. 13.5---27.4%; one year: 15.9---31% vs. 17.4---46.5%), as was in-hospital mortality (5.5---14% vs. 3.8---12%) in Portuguese and European studies, respectively. Length of stay was comparable. The studies were performed in very different hospital settings and data on treatment were scarce. Conclusions: Gaps were identified in treatment and clinical pathways of patients with AHF. Based on the results of this review, collection and investigation of data on the disease and treatment solutions, training in disease management, and improved organization of healthcare should be the subject of further investment.

International Journal of Cardiology, 2017

Background: This study was undertaken to evaluate trends in heat failure hospitalizations (HFHs) and 1-year mortality of HFH in Lombardy, the largest Italian region, from 2000 to 2012. Methods: Hospital discharge forms with HF-related ICD-9 CM codes collected from 2000 to 2012 by the regional healthcare service (n = 699797 in 370538 adult patients), were analyzed with respect to in-hospital and 1-year mortality; Group (G) 1 included most acute HF episodes with primary cardiac diagnosis (70%); G2 included cardiomyopathies without acute HF codes (17%); and G3 included non-cardiac conditions with HF as secondary diagnosis (13%). Patients experiencing their first HFH since 2005 were analyzed as incident cases (n = 216782). Results: Annual HFHs number (mean 53830) and in-hospital mortality (9.4%) did not change over the years, the latter being associated with increasing age (p b 0.0001) and diagnosis Group (G1 9.1%, G2 5.6%, G3 15.9%, p b 0.0001). Incidence of new cases decreased over the years (3.62 [CI 3.58-3.67] in 2005 to 3.13 [CI 3.09-3.17] in 2012, per 1000 adult inhabitants/year, p b 0.0001), with an increasing proportion of patients aged ≥ 85 y (22.3% to 31.4%, p b 0.0001). Mortality lowered over time in b 75 y incident cases, both in-hospital (5.15% to 4.36%, p b 0.0001) and at 1-year (14.8% to 12.9%, p = 0.0006). Conclusions: The overall burden and mortality of HFH appear stable for more than a decade. However, from 2005 to 2012, there was a reduction of new, incident cases, with increasing age at first hospitalization. Meanwhile, both in-hospital and 1-year mortality decreased in patients aged b 75 y, possibly due to improved prevention and treatment.

Journal of Clinical Medicine

Objective: The objective of this study was to describe the rates of adverse clinical outcomes, including all-cause mortality, heart failure (HF) hospitalization, myocardial infarction, and stroke, in patients newly diagnosed with HF to provide a comprehensive picture of HF burden. Methods: This was a retrospective and observational study, using the BIG-PAC database in Spain. Adults, newly diagnosed with HF between January 2013 and September 2019 with ≥1 HF-free year of enrolment prior to HF diagnosis, were included. Results: A total of 19,961 patients were newly diagnosed with HF (43.5% with reduced ejection fraction (EF), 26.3% with preserved EF, 5.1% with mildly reduced EF, and 25.1% with unknown EF). The mean age was 69.7 ± 19.0 years; 53.8% were men; and 41.0% and 41.5% of patients were in the New York Heart Association functional classes II and III, respectively. The baseline HF treatments included beta-blockers (70.1%), renin–angiotensin system inhibitors (56.3%), mineralocort...

2013

H eart failure (HF) is an important healthcare issue because of its high prevalence, mortality, morbidity, and cost of care. As of 2012, 2.4% of the US population has HF, with prevalence increasing with age such that among those ≥80 years of age, almost 12% of both men and women have HF. 1 Mortality is high, with 50% of Medicare beneficiaries not surviving 3 years after an HF hospitalization. 2 Although hospitalizations for HF have decreased slightly in recent years, 3 the cost of HF care is high and will remain a significant concern for the US healthcare system. If one assumes a continuation of present care practices, an increase in costs is expected, in part because patients with HF will survive longer because of the development and implementation of life-prolonging therapies, as well as aging of the population, which will lead to more patients at risk for developing HF.

Research Square (Research Square), 2022

To describe healthcare resource utilization (HCRU) of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Adults with ≥ 1 HF diagnosis and ≥ 1 year of continuous enrolment before the corresponding index date (1/January/2016) were identi ed through the BIG-PAC database. Rate per 100 person-years of all-cause and HFrelated HCRU during the year after the index date were estimated using bootstrapping with replacement. 21,297 patients were included, of whom 48.5% had HFrEF, 38.6% HFpEF and 4.2% HFmrEF, with the rest being of unknown EF. Mean age was 78.8 ± 11.8 years, 53.0% were men and 83.0% were in NYHA functional class II/III. At index, 67.3% of patients were taking renin angiotensin system inhibitors, 61.2% beta blockers, 23.4% aldosterone antagonists and 5.2% SGLT2 inhibitors. Rates of HF-related outpatient visits and hospitalization were 968.8 and 51.6 per 100 person-years, respectively. Overall, 31.23% of patients were hospitalized, mainly because of HF (87.88% of total hospitalizations); HF hospitalization length 21.06 ± 17.49 days (median 16; 25th, 75th percentile 9-27). HF hospitalizations were the main cost component: inpatient 73.64%, pharmacy 9.67%, outpatient 9.43%, and indirect cost 7.25%. Rates of all-cause and HF-related HCRU and healthcare cost were substantial across all HF subgroups, being higher among HFrEF compared to HFmrEF and HFpEF patients. HCRU and cost associated with HF are high in Spain, HF hospitalizations being the main determinant. Medication cost represented only a small proportion of total costs, suggesting that an optimization of HF therapy may reduce HF burden. Retrospective cohort study using data from BIG-PAC database in Spain. BIG-PAC is a longitudinal and de-identi ed database that includes healthcare data of 1.8 million patients from primary care and hospital centers, across seven Autonomous Communities in Spain. Several studies have demonstrated its representativeness of the Spanish population and its ability to accurately determine the clinical pro le, treatments, healthcare resource utilization and costs in Spain [3, 4,. This study was approved by the Investigation Ethics Committee of the Consorci Sanitari from Terrassa (Barcelona, Spain). No informed consent was required in this study, as secondary data were used and all information was completely anonymized and dissociated from patients' identity. For this study, a prevalent cohort that included adults with at least one inpatient or outpatient HF diagnosis, and at least one year of continuous enrolment before the corresponding index date (1 January 2016) was analyzed. Patients were excluded if they had less than one year of continuous enrolment before the index date, < 18 years at index date, or had chronic kidney disease stage V that required dialysis at any time before the index date. Clinical characteristics, including demographics, HF diagnosis, cardiovascular risk factors, vascular disease, chronic kidney disease by stage [26] and other comorbidities, as well as treatments were determined at baseline. Comorbidities were based on data any time up to the index date, unless otherwise speci ed. The International Classi cation of Diseases (ICD)-9 and ICD-10 codes () were considered for the diagnosis of HF and comorbidities (supplementary table ). Treatments during one year before index date were recorded from the registries for dispensing medicines, according to the Anatomical Therapeutic Chemical Classi cation System . Data were strati ed by EF subgroups, HFpEF: EF ≥ 50%; HFrEF: EF ≤ 40%; HFmrEF: EF > 40-<50%; HF with unspeci ed EF (HFuEF): patients without an echocardiographic result at baseline. During the year after the index date, HF-related hospitalizations, outpatient visits, costs as well as all-cause HCRU were estimated using cost data from the Spanish National Health Service, and included: inpatient (number of hospitalizations > 24 hours, length of hospital stays, cost), outpatient (number of visits to general practitioners, the number of visits to the specialist, cost), emergency visits (number of visits to the emergency department, cost), pharmacy (total prescription cost for HF and non-HF medications), and indirect cost relating to work morbidity-glucose co-transporter-2 inhibitors [SGLT2i]) and HF with preserved EF (HFpEF) (i.e. some SGLT2i), leading to a reduction of HF burden . HF is associated with huge direct and indirect costs, largely due to HF hospitalization, representing 1-2% of total healthcare costs in Europe and United States [16][18]. As a result, it is important to ascertain the main determinants of HF costs, in order to optimize the management of HF that may allow a reduction in HF costs . Although some studies have analyzed the clinical pro le and management of HF strati ed by EF (HFrEF, HF with mildly reduced EF [HFmrEF] and HFpEF) , there are very few studies that have focused on identifying cost drivers according to HF phenotype . This study aimed to describe healthcare resource utilization (HCRU) and direct medical costs including HF-related and all-cause outpatient visits, hospitalizations, specialist visits, and poly-pharmacy, strati ed by EF subgroups, through the analysis of a nationally representative Spanish database.

Healthcare, 2022

Chronic heart failure (CHF) affects millions of people across the world, with increasing trends in prevalence, putting ever increasing pressure on the healthcare system. The aim of this study was to assess the financial burden of CHF hospital care on the public healthcare sector in Romania by estimating the number of inpatient episodes and the associated costs. Additionally, societal costs associated with missed work and premature death of CHF patients were also estimated. The national claims database was analyzed to estimate the number of CHF patients. Cost data was extracted from a pool of nine public hospitals in Romania. In 2019, 375,037 CHF patient episodes were identified on specific wards at the national level. The average cost calculated for the selected nine hospitals was EUR 996. The calculated weighted national average cost per patient episode was EUR 1002, resulting in a total cost of EUR 376 million at the national level. The cost of workdays missed summed up to EUR 122...

European Heart Journal, 2018

European Journal of Heart Failure, 2021

The HFA Atlas survey was conducted in 2018-2019 in 42 ESC countries. The quality and completeness of source data varied across countries. The median incidence of HF was 3.20 [interquartile range (IQR) 2.66-4.17] cases per 1000 person-years, ranging from ≤2 in Italy and Denmark to >6 in Germany. The median HF prevalence was 17.20 (IQR 14.30-21) cases per 1000 people, ranging from ≤12 in Greece and Spain to >30 in Lithuania and Germany. The median number of HF hospitalizations was 2671 (IQR 1771-4317) per million people annually, ranging from <1000 in Latvia and North Macedonia to >6000 in Romania, Germany and Norway. The median length of hospital stay for an admission with HF was 8.50 (IQR 7.38-10) days. Diagnostic and management resources for HF varied, with high-income ESC member countries having substantially more resources compared with middle-income countries. The median number of hospitals with dedicated HF centres was 1.16 (IQR 0.51-2.97) per million people, ranging from <0.10 in Russian Federation and Ukraine to >7 in Norway and Italy. Nearly all countries reported full or partial reimbursement of standard GDMT, except ivabradine and sacubitril/valsartan. Almost all countries reported having NHFS or working groups and nearly half had HF patient organizations.

Journal of Public Health

Aim To estimate the comprehensive healthcare costs of heart failure (HF) and determine the utilization of healthcare resources (HRU) for 2 years following index hospitalization. Subjects and methods The Manipal Heart Failure Registry (MHFR) is a prospective registry analyzing the financial burden and HRU in 610 patients with HF. Costs incurred by patients during 2 years following index hospitalization were estimated, and their association with socio-demographic and clinical factors were calculated. After 54 (8.8%) in-hospital mortalities, 556 patients were followed up for 2 years. Results The mean age of the study cohort was 65.08 ± 13.6 years, and 245 (40.2%) were females. Based on the ejection fraction (EF), 506 (82.9%) patients were diagnosed as having HF with reduced EF. Average hospital stay during index admission was 5.3 ± 2.9 days. Total expenditure during index hospitalization was INR 36.3 million and during 2-year follow-up was INR 45.2 million. Average total expenditure per patient was INR 133,663. The average out-of-pocket expense was INR 82,766 and average health insurance coverage was INR 50,896. Difference in expenditure was significant (P < 0.05) between specific groups, i.e., etiologies, genders, HF phenotypes, age groups, and healthcare insurance types. Conclusion Healthcare expenditure of patients with HF in India is much lower than for the western counterparts. Higher utilization of healthcare resources in HF patients with ischemic etiology, non-compliant to medications, and elderly (age > 60 years) was associated with increased expenses. Interventional procedures and implantations account for the bulk of the expenses in ischemic HF patients. Trial registration number Clinical Trial Registry of India: CTRI/2017/11/010395; National Institute of Health (NIH) clinical trial no.: NCT03157219.

European Journal of Heart Failure, 2010

The primary objective of the new ESC-HF Pilot Survey was to describe the clinical epidemiology of outpatients and inpatients with heart failure (HF) and the diagnostic/therapeutic processes applied across 12 participating European countries. This pilot study was specifically aimed at validating the structure, performance, and quality of the data set, for continuing the survey into a permanent registry.

Revista Española de Cardiología (English Edition), 2009

European Journal of Heart Failure