Heart Failure Cases on the Rise Across the Globe

Nicola Bragazzi, MD

Results of a recent study from an international team of investigators suggests the number of heart failure cases has nearly doubled in the last three decades.

An analysis of data from 195 countries between 1990 and 2017, results indicate the absolute number of prevalent heart failure cases increased by more than 91% during that time period while years lived with disability among heart failure patients increased by 106%.

"Our study challenges the common view that heart disease is fully under control," said study investigator Nicola Bragazzi, MD, of York University in Toronto, in a statement. "Despite progress and achievements, the global burden imposed by heart failure is significantly growing."

Bragazzi and a team of colleagues designed the current study with an interest in evaluating the burden and underlying causes of heart failure at national, regional, and international levels. Using the Global Burden of Disease study from 2017, investigators obtained data from 7 super-regions, 21 regions, and 195 countries and territories from 1990-2017.

Using this data, investigators hoped to compare age-standardized prevalence of heart failure and years lived with disability based on age, sex, sociodemographic index, and location. Investigators also designed additional analysis’s to assess proportion of heart failure age-standardized prevalence rates according to 23 underlying causes, including hypertensive heart disease, cardiomyopathy, mitral valve disease, and others.

Upon analysis, investigators found the age-standardized prevalence of heart failure in 2017 was 831.0 per 100,000 people and the years lived with disability rate in 2017 was 128.2 per 100,000 people. Compared to rates in 1990, age-standardized prevalence of heart failure decreased by 7.2% and years lived with disability rate declined 0.9%. When assessing absolute change, investigators found the number of heart failure cases increased by 91.9% from 1990-2017 while years lived with disability increased by 106.0% during the same time period.

Additionally, investigators noted there was significant geographic and socio-demographic variation in the levels and trends of heart failure burden during the study period. When assessing underlying causes of heart failure, ischemic heart disease accounted for the greatest proportion (26.5%) of the age-standardized prevalence rate in 2017—other leading factors included hypertensive heart disease (26.2%) and chronic obstructive pulmonary disease (23.4%).

Investigators pointed out results of their study also pointed to disparities in prevalence according to sociodemographic index of a country. Specifically, investigators observed a 20.3% decrease in age-standardized prevalence rate from 1990-2017 among high-income nations while those considered to be low, low-middle, and middle-income countries all saw increases in prevalence.

"In low- and middle-income countries, the compliance to healthy lifestyle behaviors including healthy diets, physical activity and smoking cessation was rather poor,” wrote investigators. “More targeted strategies aimed to modify multiple risk factors and improve the availability and affordability of medical care for heart failure are urgently needed for these countries.”

This study, “Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017,” was published in the European Journal of Preventive Cardiology.