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Trends in heart failure epidemiology between 2007 and 2016 in Piedmont, Italy: findings from the Epi-HF study

Session Poster Session 1

Speaker Davide Castagno

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : D Castagno (Turin,IT), E Pivetta (Turin,IT), R Gnavi (Turin,IT), R Picariello (Turin,IT), G Costa (Turin,IT), M Maule (Turin,IT), A Maisano (Turin,IT), E Strippoli (Turin,IT), F Gaita (Turin,IT), M Rinaldi (Turin,IT)

Authors:
D Castagno1 , E Pivetta2 , R Gnavi3 , R Picariello3 , G Costa4 , M Maule2 , A Maisano1 , E Strippoli3 , F Gaita1 , M Rinaldi5 , 1Division of Cardiology, Department of Medical Sciences, University of Turin - Turin - Italy , 2Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin - Turin - Italy , 3Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco - Turin - Italy , 4Department of Clinical and Biological Science, University of Turin - Turin - Italy , 5Cardiovascular Surgery, Department of Surgical Sciences, University of Turin - Turin - Italy ,

On behalf: EPi-HF - Heart Failure in Piedmont: Trends in Epidemiology

Citation:

Background 
Differences exist in epidemiology of heart failure (HF) between countries worldwide but recent data on HF temporal trends in Italy are lacking. 

Purpose 
To describe HF epidemiology in Piedmont (about 4.5 million people in Northwest Italy) by analysing trends of first hospitalisation, readmission, survival and variables associated with outcome. 

Methods 
This retrospective cohort study was based on hospital discharge records, tracking all hospitalisations occurred in Piedmont. The study population included residents first discharged between 2007 and 2016 with a principal diagnosis of HF. Endpoints were all-cause mortality and cardiovascular (CV) hospitalisation. Hospitalisation rates were age-standardised by direct standardisation. Crude case-fatality rates were calculated at 30 days, 1 and 3 years from discharge. Kaplan-Meier analyses were used to determine survival. Cox models were used to investigate factors associated with outcome.

Results 
74292 patients were admitted for the first time with HF (female 48.6%, mean age 77.5 years). The average length of in-hospital stay was 13 days. Since 2007, rates of first HF hospitalisation decreased significantly from 22.3 to 17.9 cases/1000 inhabitants and from 21.1 to 17.2 cases/1000 inhabitants in men and women respectively (Fig.A). In-hospital mortality was 10.7% overall. Mortality was 4.2%, 20.3% and 39% at 30 days, 1 and 3 years respectively. Readmission rates were 13.1%, 48.6%, and 68.9% after 30 days, 1 and 3 years, respectively. Post-discharge one-year mortality increased significantly from 2007 to 2016 in both sexes whereas CV-hospitalisations decreased (Fig.B). At multivariable analysis several factors were associated with outcome (Tab).

Conclusions 
During the last decade, in Piedmont, rates of first HF hospitalisation decreased progressively. However, post-discharge mortality remained high.

1 year all-cause mortality

1 year CV-rehospitalisation

HR

95%CI

HR

95%CI

Female (vs. Male)

1.07

1.03-1.12

1.17

1.12-1.21

Age (years) < 65

65-74

75-84

>84

1.00

1.96

3.52

7.41

-

1.74-2.21

3.16-3.93

6.63-8.29

-

1.04

0.91

0.84

-

0.99-1.10

0.86-0.96

0.78-0.89

Chronic renal failure

1.43

1.36-1.49

1.21

1.15-1.27

Chronic Obstructive Pulmonary Disease

1.17

1.11-1.23

0.95

0.90-0.99

Cancer

1.70

1.62-1.79

0.96

0.91-1.02

Myocardial infarction

0.98

0.93-1.02

1.26

1.21-1.32

Diabetes

1.02

0.97-1.06

1.11

1.06-1.15

Atrial fibrillation

0.99

0.95-1.03

1.31

1.26-1.35

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