Global Data Show HF Rates, Costs on the Rise


Implications of these findings include a more clear understanding of the burden imposed by heart failure (HF), which encompasses the cost of care and adverse health outcomes.

New study findings show that up to 2% of adults may have heart failure (HF), with substantial implications for public health, according to data published online today in the journal Heart.1 The finding also revealed that adults with the condition have a greater risk of significant care costs and adverse health outcomes from the disease.

Data from digital health care systems of 11 countries for 2018 through 2020 were used for the CaReMe (CArdioRenal and Metabolic disease) study, with the investigators incorporating broad and strict definitions of HF and data on a contemporary cohort of 629,624 individuals with HF. The broad definition of HF accounted for patients whose HF was diagnosed in a primary care or hospital setting, and the strict definition applied to patients with a history of HF-related hospital admissions. Primary outcomes were prevalence, key clinical adverse outcomes, and HF costs for the 11 countries: Belgium, Canada, Germany, Israel, Italy, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom. Each country had 3 patient cohorts: cross-sectional (contemporary patient characteristics), longitudinal risks (1-year event rates), and longitudinal costs (hospital related health care costs for up to 5 years).

“Few studies have used both digital medical records and national registry data to assess the impact of HF in the round,” noted the researchers in a statement. “And those that have, have drawn on highly selected patient groups, meaning that the findings are unlikely to be generally representative.”2

The broad definition of HF produced a higher prevalence of HF compared with the strict definition: 2.01% (95% CI, 1.65%-2.36%) vs 1.05% (95% CI, 0.85%-1.25%). Among the types of HF measured—HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)—with 8.1% of patients (n = 51,442) having these data recorded, the most common type was HFpEF in 42.1% (95% CI, 31.5%-52.8%), followed by HFrEF in 39.1% (95% CI, 30.3%-47.8%) and HF with mildly reduced ejection fraction in 18.8% (95% CI, 13.5%-24.0%).

In addition, among the overall HF cohort (mean age, 75.2 [95% CI, 74.0-76.4] years), ischemic heart disease was seen in 48.8% (95% CI, 40.9%-56.8%), atrial fibrillation in 44.1% (95% CI, 39.1%-49.0%), and diabetes in 34.5% (95% CI, 29.4%-39.6%). The most common New York Heart Association disease class was class II/III in 74%, and β-blockers were the most frequently administered disease-modifying treatment in 69.3% (95% CI, 62.5%-76.1%).

For the 26.9% of patients who had estimated glomerular filtration rate (eGFR) data in their medical record, 49% were shown to have stage III-V chronic kidney disease (CKD; eGFR < 60 mL/min/1.73 m2). Per 100 patient-years (PY), the highest event rates were seen from cardiorenal disease (HF or CKD), at 19.3 (95% CI, 11.3-27.1), and all-cause mortality, at 13.1 (95% CI, 11.1-15.1). Individually, for HF related to cardiorenal disease, the event rate was 15 per 100 PY, and for CKD, 6 per 100 PY. Very low rates were seen overall for peripheral artery disease (PAD), stroke, and myocardial infarction (MI), at 1.4, 1.8, and 2.7 events per 100 PY, respectively.

Overall, Portugal (2.9%) had the greatest prevalence of HF, and the United Kingdom (1.4%) had the lowest prevalence of HF.

Hospitalization cost data were available on 74% of patients, and they came from Canada, Italy, Portugal, Spain, Sweden, and the United Kingdom. Through the 5-year mark, costs related to HF were undeniably higher than those for CKD, MI, PAD, and stroke; these totals comprised baseline and cumulative costs. The steepest increase was seen in the United Kingdom, whereas Italy had the lowest increase.

“Most health care costs were attributable to cardiorenal events, higher than those stemming from atherosclerotic cardiovascular diseases,” the study investigators wrote, “illustrating high rates of repeated HF events and mortality following HF.”

Strengths of these study findings include that data were collected by health care professionals from a variety of settings who have interacted with patients living with HF, not just those who practice in a cardiology setting, and that the authors’ findings have potential to enable clinicians to be prepared for whenever treatments produce heterogeneous results among a population.

“With rapidly improving treatments for HF, there is considerable public health potential in understanding the contemporary burden of HF and the importance of optimizing its management,” they concluded. “These individuals are at significant risk of adverse outcomes and associated costs, predominantly driven by hospitalisations for HF or CKD.”


1. Norhammar A, Bodegard J, VAnderheyden M, et al. Prevalence, outcomes and costs of a contemporary, multinational population with heart failure. Heart. Published online February 13, 2023. doi:10.1136/heartjnl-2022-321702

2. Up to 2% of adults in Europe, North America, Israel likely have heart failure. News release. EurekAlert. February 13, 2023. Accessed February 13, 2023.

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