Background and purpose: Limited or non-existing data is available on the prevalence, incidence, health care resource use (HCRU) and mortality associated with heart failure (HF) in Finland. We characterized these in a retrospective study based on data from biobank and clinical registries in Southwest Finland.
Methods: Adult patients with HF diagnosis (ICD-code I50) during 2004–2013 in secondary care were included in the study. Age-group specific prevalence and incidence were analysed from all patients with I50-code in their electronic health records (n=15 594). A more detailed characterization, HCRU and mortality analyses were performed for HF diagnosed patients who had given an Auria Biobank consent and had NT-proBNP >125 pg/ml (n=8 833). These patients were further stratified by left ventricular ejection fraction as follows: LVEF<40% (HFrEF); LVEF≥40% (HFpEF) or unknown (LVEF unknown). HCRU was stratified into inpatient, outpatient and ER visits.
Results: Prevalence and incidence rates remained stable during the follow-up. The incidence of HF was 3.22/1 000 inhabitants and prevalence 6.3/1 000 inhabitants in the total study cohort in 2013. When extrapolating the age-specific prevalence this gave an estimate of 34 145 HF patients in Finland. In the more detailed analysis from 8 833 HF patients (average±SD age 77.1±11.2) in the Auria Biobank registry, 1 115 (12.6%) patients had HFrEF (females 31.3%), 1 449 (16.4%) HFpEF (females 50.9%) and 6 269 (71%) had unknown EF (females 52.1%). The most common comorbidities were essential hypertension (58%), chronic elevated creatinine (57.3%), atrial fibrillation and flutter (55.1%) and chronic ischemic heart disease (46.4%). During the first year from the index date, the patients had on average 12.7 hospital days, and during the following four years the number was on average 5.2 hospital days per year. Mortality during the 1st year from the index date was 25%. Even in the youngest age group, 18–54 years, five-year mortality was 25%. Higher age was the strongest predictor of mortality. HFrEF and HFpEF patients had equally poor prognosis (five-year mortality 55%, age- and gender-adjusted analysis) and the prognosis was the worst amongst the patients with unknown LVEF (five-year mortality 68%).
Conclusions: In this registry-based epidemiological study the incidence of HF was 3.22/1 000 inhabitants and prevalence 6.3/1 000 inhabitants in Southwest Finland. The patients had the highest HCRU in secondary care during the first year after the index and spent on average 5.2 days in hospital during the following four years. HFrEF and HFpEF patients had an equally poor prognosis with 55% five-year mortality. The high mortality rate highlights the severity of the disease and calls for improved methods in the care. The validity of the HF diagnosis, treatment patterns and the characterization of patients whose HCRU is high, are being further analysed in an ongoing study.