Focus on: Epidemiology of Cardiovascular Disease in Spain Over the Past 20 Years (III)
Epidemiology of Heart Failure in Spain Over the Last 20 YearsEpidemiología de la insuficiencia cardiaca en España en los últimos 20 años

https://doi.org/10.1016/j.rec.2013.03.012Get rights and content

Abstract

Heart failure is a major health care problem in Spain, although its precise impact is unknown due to the lack of data from appropriately designed studies. In contrast with the 2% prevalence of heart failure elsewhere in Europe and in the United States, studies in Spain report figures of 5%, probably because of methodological limitations. Heart failure consumes enormous quantities of health care resources; it is the first cause of hospitalization in persons aged 65 years or older and represents 3% of all hospital admissions and 2.5% of health care costs. There are two patterns of heart failure: one with preserved systolic function, more often associated with high blood pressure, and another with depressed systolic function, more often associated with ischemic heart disease. In 2010, heart failure accounted for 3% of all deaths in men and for 10% of all deaths in women. In recent years, the mortality rate from heart failure has gradually fallen. The rise in hospital admissions for heart failure and the decrease in mortality from this cause could partly be explained by temporary changes in diagnostic coding, but there is evidence that the reduced mortality could also be due to adherence to clinical practice guidelines.

Resumen

La insuficiencia cardiaca en un problema sanitario de primer orden en nuestro país, aunque no disponemos de cifras que permitan dimensionar su impacto con exactitud por falta de estudios con diseño apropiado. Frente a una prevalencia de insuficiencia cardiaca del 2% en otros países europeos y en Estados Unidos, los estudios en España arrojan cifras del 5%, probablemente a causa de sus limitaciones metodológicas. La insuficiencia cardiaca consume enormes recursos sanitarios: es la primera causa de hospitalización de mayores de 65 años y representa el 3% de todos los ingresos hospitalarios y el 2,5% del coste de la asistencia sanitaria. Hay dos patrones de insuficiencia cardiaca, uno con función sistólica preservada, más asociado a la hipertensión, y otro con función deprimida, más relacionado con la cardiopatía isquémica. En 2010, la insuficiencia cardiaca constituyó el 3% del total de defunciones de varones y el 10% de las de mujeres. La tasa de mortalidad por insuficiencia cardiaca ha ido reduciéndose en los últimos años. Los cambios temporales en la codificación diagnóstica podrían explicar parte del aumento en los ingresos hospitalarios y del descenso en la mortalidad por insuficiencia cardiaca, aunque hay indicios de que la adherencia a las guías de práctica clínica puede haber reducido su mortalidad.

Section snippets

INTRODUCTION

Heart failure (HF) is a major concern in public health.1 In the developed world, this disease affects approximately 2% of the adult population, a prevalence that increases exponentially with age. The prevalence is lower than 1% in the population aged less than 50 years but doubles with each decade, and exceeds 8% in persons aged more than 75 years.2 In Spain, the large number of patients with HF is essentially due to progressive population aging. In the interval between the 1991 census and 1

INCIDENCE AND PREVALENCE OF HEART FAILURE IN SPAIN

Incidence is defined as the number of new cases of a disease appearing in a given population over a specific period. In Spain, there is only one study of the incidence of HF.11 This study was performed the population of Puerto Real, a provincial town in the southwest of the country, and analyzed the population older than 14 years (267 231 inhabitants) registered with the Spanish National Health Service between 2000 and 2007. Diagnosis of HF was based on the Framingham clinical criteria. The

DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF PATIENTS WITH HEART FAILURE IN SPAIN

Despite the discrepancies in the reported incidence and prevalence of HF, this disease clearly has a substantial impact on health care in Spain. For this reason, research into the causes of HF and its risk factors, clinical profile, and associated comorbidities, etc., are important to plan appropriate prevention and treatment strategies. Because of the environmental, dietary, and cultural peculiarities of a Mediterranean country such as Spain, the risk factors and clinical course of patients

HOSPITAL ADMISSIONS FOR HEART FAILURE

The natural history of HF is punctuated by decompensations that usually require hospitalization and tend to follow a bimodal pattern, with more frequent peaks after diagnosis (30% of readmissions in HF) and in the final stage of the disease (50% of readmissions).32 In Spain, as in other industrialized countries, HF is the leading cause of hospitalization in persons older than 65 years.7 One direct consequence is the financial burden on the Spanish National Health Service. In 1997, Antoñanzas et

HEART FAILURE AS A CAUSE OF DEATH

In the European Union, cardiovascular diseases are the principle cause of death,49 whereas in Spain they come second to cancer.50 In Spain, HF is the fourth cause of cardiovascular death (after ischemic heart disease, cerebrovascular disease, and other heart diseases) and is responsible for 10% of deaths from a circulatory cause in men and 16% in women. Data from Spain's National Institute of Statistics50 indicate that HF caused an absolute 3% of deaths in men and 10% in women in 2010. Overall,

CONCLUSIONS

Historically, in Spain, there has been a lack of reliable nationwide, population-based studies to allow accurate measurement of the impact of HF. While the prevalence of HF in other European countries and the United States is approximately 2%, Spanish studies report figures of 5% or higher. This difference is unlikely to reflect reality and is more likely due to methodological limitations of studies in Spain.

The clinical characteristics of patients with HF form two typical patterns: one with

CONFLICTS OF INTEREST

None declared.

References (61)

  • G. Galindo Ortego et al.

    Pacientes con el diagnóstico de insuficiencia cardiaca en Atención Primaria: envejecimiento, comorbilidad y polifarmacia

    Aten Primaria

    (2011)
  • L. Alonso-Pulpón

    La «epidemia» de insuficiencia cardíaca: ¿son todos los que están y están todos los que son?

    Rev Esp Cardiol

    (2002)
  • E. Frigola-Capell et al.

    Tendencias y variables predictoras de hospitalización, reingreso y duración de la estancia hospitalaria en pacientes ambulatorios con insuficiencia cardíaca

    Rev Clin Esp

    (2013)
  • M. Anguita Sánchez

    Características clínicas, tratamiento y morbimortalidad a corto plazo de pacientes con insuficiencia cardíaca controlados en consultas específicas de insuficiencia cardíaca. Resultados del Registro BADAPIC

    Rev Esp Cardiol

    (2004)
  • G.C. Rodríguez Roca et al.

    Características clínicas de los pacientes diagnosticados de insuficiencia cardíaca crónica asistidos en Atención Primaria. Estudio CARDIOPRES

    Rev Clin Esp

    (2007)
  • F. Otero-Raviña et al.

    Estudio gallego de insuficiencia cardiaca en atención primaria (estudio GALICAP)

    Rev Esp Cardiol

    (2007)
  • G. Galindo Ortego et al.

    Pacientes con el diagnóstico de insuficiencia cardiaca en Atención Primaria: envejecimiento, comorbilidad y polifarmacia

    Aten Primaria

    (2011)
  • J.R. González-Juanatey et al.

    Insuficiencia cardiaca en consultas ambulatorias: comorbilidades y actuaciones diagnóstico-terapéuticas por diferentes especialistas. Estudio EPISERVE

    Rev Esp Cardiol

    (2008)
  • B. De Rivas Otero et al.

    Perfil clínico y patrones de manejo en los pacientes con insuficiencia cardiaca atendidos ambulatoriamente en España: estudio INCA (Estudio Insuficiencia Cardiaca)

    Aten Primaria

    (2009)
  • R. Boix Martínez et al.

    Mortalidad por insuficiencia cardíaca en España, 1977-1998

    Rev Esp Cardiol

    (2002)
  • C. Brotons et al.

    Tendencias de la morbimortalidad por insuficiencia cardíaca en Cataluña

    Rev Esp Cardiol

    (1998)
  • M.F. Jiménez-Navarro et al.

    Evolución de las hospitalizaciones por insuficiencia cardiaca en Andalucía en la última década

    Rev Clin Esp

    (2006)
  • G. Permanyer Miralda et al.

    Características basales y determinantes de la evolución en pacientes ingresados por insuficiencia cardíaca en un hospital general

    Rev Esp Cardiol

    (2002)
  • A. Riesgo et al.

    Influencia del sexo del paciente en la forma de presentación y en el tratamiento de la insuficiencia cardiaca aguda en los servicios de Urgencias españoles

    Med Clin (Barc)

    (2010)
  • F. Formiga et al.

    Hospitalization due to acute heart failure. Role of the precipitating factors

    Int J Cardiol

    (2007)
  • A. García Castelo et al.

    Utilización de recursos diagnósticos y terapéuticos en paciente ingresados por insuficiencia cardíaca: influencia del servicio de ingreso (estudio INCARGAL)

    Rev Esp Cardiol

    (2003)
  • F. Formiga et al.

    Admission characteristics predicting longer length of stay among elderly patients hospitalized for decompensated heart failure

    Eur J Intern Med

    (2008)
  • B. Pérez-Gómez et al.

    Accuracy of cancer death certificates in Spain: a summary of available information

    Gac Sanit

    (2006)
  • F. Pons et al.

    Mortalidad y causas de muerte en pacientes con insuficiencia cardiaca: experiencia de una unidad especializada multidisciplinaria

    Rev Esp Cardiol

    (2010)
  • L. Grigorian-Shamagian et al.

    Why and when do patients with heart failure and normal left ventricular ejection fraction die? Analysis of >600 deaths in a community long-term study

    Am Heart J

    (2008)
  • Cited by (0)

    View full text