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Epidemiology of heart failure: incidence, prevalence, and risk factors from a systematic review

Session Poster Session 1

Speaker Carolyn Sp Lam

Event : Heart Failure 2019

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

Authors : C Lam (Singapore,SG), M Stokes (Saint-Laurent, Quebec,CA), L Qin (Gaithersburg, MD,US), J Medina (Madrid,ES), S Nambiar (Waltham, MA,US), G Saraiva (Gaithersburg, MD,US)

Authors:
C Lam1 , M Stokes2 , L Qin3 , J Medina4 , S Nambiar5 , G Saraiva3 , 1National Heart Centre Singapore & Duke-National University of Singapore - Singapore - Singapore , 2Evidera - Saint-Laurent, Quebec - Canada , 3AstraZeneca - Gaithersburg, MD - United States of America , 4AstraZeneca - Madrid - Spain , 5Evidera - Waltham, MA - United States of America ,

Citation:

INTRODUCTION: Heart failure (HF) is a global public health problem. Recent data on the epidemiology of HF from population-based sources that identify cases using echocardiographic assessments are limited.
PURPOSE: To examine the contemporary worldwide incidence, prevalence, and clinical correlates of HF with reduced (HFrEF) and preserved ejection fraction (HFpEF).
METHODS: Systematic review of peer-reviewed original papers, published in English between January 2013–August 2018, focused on HF prevalence and incidence, and including echocardiographic data. 
RESULTS: From 11 identified studies (TABLE), prevalence of HFrEF and HFpEF ranged from 3.8¬–4.2% and 3.5–5.5%, respectively (from 3 community-based studies in Germany, China, Brazil); whereas incidence of HFrEF and HFpEF ranged from 0.5–9.3 and 0.6–15.1 per 1,000 person-years respectively (from 8 studies in US, EU, Japan, Australia). Prevalence and incidence of HFpEF was similar to or higher than that of HFrEF in all studies except Brouwers, 2013. Higher HF incidence regardless of EF was reported with older age, physical inactivity, hypertension, myocardial infarction, left ventricular hypertrophy, and increased natriuretic peptides. Female and renal disease were associated with higher HFpEF incidence. One study examining trends in the US between 2000-2010 showed overall decline in HF incidence (more in HFrEF than HFpEF), with increasing proportion of incident HFpEF (vs. HFrEF). 
CONCLUSIONS: The worldwide prevalence and incidence of HF remain high. Despite advances in identifying individuals at risk, HF, especially HFpEF, remains a global public health problem.

Study (Country)

Study Type

Study Years

Population

Diagnostic Criteria

Prevalence/Incidence

Factors Associated with Higher Prevalence/Incidence

HFrEF

HFpEF

HFrEF

HFpEF

Tiller, 2013 (Germany)

Prevalence

2002-2006

Community-based (45-83 years old)

>50% (HFrEF) ≤50% (HFpEF)

4.2%

4.1%

Hypertension, MI

Hypertension

Guo, 2016 (China)

Prevalence

2012-2013

Community-based (≥35 years old)

>50% (HFrEF) ≤50% (HFpEF)

NR

3.5%

NR

M: NR

F: Hypertension, heart disease

Jorge, 2016 (Brazil)

Prevalence

2011-2012

Community residents registered in primary medical care (45-99 years old)

>50% (HFrEF) ≤50% (HFpEF)

3.8%

5.5%

NR

NR

Kraigher-Krainer, 2013 (US)

Incidence

1986-1990

Community-based, elderly (67-97 years old)

EF≤45% (HFrEF) EF>45% (HFpEF)

9.3% (over mean 10 yrs.)

9.3 per 1,000 PY

9.5% (over mean 10 yrs.)

9.5 per 1,000 PY

Lowest activity level

Seliger, 2015 (US)

Incidence

1989-1993

Community based, ≥65 years old

EF<45% (HFrEF) EF≥45% (HFpEF)

No LVH: 4-6 per 1,000 PY

LVH: 4-20 per 1,000 PY (NT-proBNP tertiles 1-3)

No LVH: 6-10 per 1,000 PY

LVH: 7.5-16 per 1,000 PY (NT-proBNP tertiles 1-3)

LVH, hs-cTnT or NT-proBNP

Gerber, 2015 (US)

Incidence

2000-2010

Olmstead County, MN

EF<50% (HFrEF) EF≥50% (HFpEF)

2002: 1.5 (F)

1.9 (M) per 1,000 PY

2010: 0.80 (F)

1.4 (M) per 1,000 PY

2002: 1.7 (F)

1.4 (M) per 1,000 PY

2010: 1.4 (F)

1.0 (M) per 1,000 PY

NR

NR

Zhang, 2017 (US)

Incidence

2003-2013

Pts with pre-clinical diastolic dysfunction

EF≤40% (HFrEF) EF≥50% (HFpEF)

3.5 per 1,000 PY

15.1 per 1,000 PY

Non-Hispanic black vs. white, higher age, diabetes, MI, renal disease

Higher age, diabetes, MI, renal disease

Brouwers, 2013 (The Netherlands)

Incidence

1997-1998

General population (28-75 years old)

EF≤40% (HFrEF) EF≥50% (HFpEF)

2.8%

(over median 11.5 yrs)

2.5 per 1,000 PY

1.5%

(over median 11.5 yrs)

1.3 per 1,000 PY

Male, higher age NT-proBNP

Female, higher age NT-proBNP, AF, increased UAE excretion and cystatin C

Ho, 2016 (US and EU multi-region)

Incidence

1979-1993

Community-based (45-75 years)

EF≤45% (HFrEF) EF>45% (HFpEF)

871 over mean 13.2 years

2.9 per 1,000 PY

795 over mean 13.2 years

2.7 per 1,000 PY

Higher age, male sex, systolic BP, BMI, hypertension, diabetes, current smoker, MI, LVH, left bundle branch block

Higher age, systolic BP, BMI, hypertension, MI

Komi, 2017 (Japan)

Incidence

NR

General population mean age: 63 years

NR

68 cases over mean 9 yrs.

0.5 per 1,000 PY

74 cases over mean 9 yrs.

0.6 per 1,000 PY

Higher plasma BNP levels

Gong, 2018 (Australia)

Incidence

2007-2015

Community residents age ≥60 with >1 HF risk factor

EF<50% (HFrEF) EF≥50% (HFpEF)

53 cases during median 4.8 years

3.0 per 1,000 PY

73 cases during median 4.5 years

4.2 per 1,000 PY

Age, male, MI, NT-proBNP

Age, BMI, diabetes, MI, AF, NT-proBNP

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