Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Estimation of Population Prevalence and Number of Patients with Heart Failure in Spain
2.3. Estimation of Ejection Fraction ≤ 40% and New York Heart Association Functional Class II–IV Prevalence in the Heart Failure Population in Spain
- RICA (National Registry for Heart Failure), carried out in internal medicine units in 52 public and private hospitals [27];
- REDINSCOR (Spanish Network for Heart Failure), carried out in HF units in 18 hospitals [27];
- BADAPIC (Database of Patients with Heart Failure), involving 62 centres with specific HF units or clinics [6];
- INCA (Heart Failure Study), involving 415 primary care physicians and 93 cardiologists [7];
- EPISERVE (Heart Failure in Outpatients), carried out by 181 primary care physicians, 172 cardiologists, and 154 internal medicine physicians [28];
- GALICAP (Galician Study of Heart Failure in Primary Care), involving 149 primary care physicians distributed in eight areas of Galicia [29].
2.4. Estimation of Glomerular Filtration Rate ≥ 30 mL/min/1.73 m² Prevalence in the Heart Failure Population in Spain
2.5. Estimation of Type 2 Diabetes Mellitus Prevalence in the Heart Failure Population in Spain
2.6. Statistical Analysis
3. Results
3.1. Estimation of Population Prevalence and Number of Patients with Heart Failure in Spain
3.2. Estimation of Ejection Fraction ≤ 40% and New York Heart Association Functional Class II–IV Prevalence in the Heart Failure Population in Spain
3.3. Estimation of Glomerular Filtration Rate ≥ 30 mL/min/1.73 m² Prevalence in the Heart Failure Population in Spain
3.4. Estimation of Type 2 Diabetes Mellitus Prevalence in the Heart Failure Population in Spain
4. Discussion
4.1. Main Findings
4.2. Reliability of Prevalence Estimates
4.3. Potential Translational Perspective
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Inclusion Criteria |
(1) Provision of signed informed consent prior to any study specific procedures |
(2) Men or women, aged ≥18 years at the time of consent |
(3) Diagnosis of HF with left ventricular EF ≤ 40%, which has been present for at least 12 months prior to enrolment |
(4) Diagnosis of symptomatic HF (NYHA functional class II–IV), within the previous 2 months |
(5) Optimally treated with pharmacological and/or device therapy for HF |
(6) NT-proBNP ≥ 600 pg/mL (or if hospitalised for HF within the previous 12 months, NT-proBNP ≥ 400 pg/mL) at enrolment. Patients with atrial fibrillation or atrial flutter must have a level ≥900 pg/mL, irrespective of history of HF hospitalization |
Exclusion Criteria |
(1) Treatment with SGLT2 inhibitors within 8 weeks prior to enrolment, or previous intolerance of an SGLT2 inhibitor |
(2) Diagnosis of type 1 diabetes mellitus |
(3) Symptomatic hypotension or systolic blood pressure <95 mmHg |
(4) Recent worsening HF or other cardiovascular events or procedures |
(5) Severe (GFR < 30 mL/min/1.73m² by CKD-EPI equation), unstable, or rapidly progressing renal disease at the time of randomization |
(6) Other conditions likely to prevent patient participation in the trial or greatly limit life expectancy |
Year of Publication | Country/Region | Study Population | Age, Years (SD) | Women,% | Age Group Prevalence, By Years | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Total | 45–54 | 55–64 | 65–74 | ≥75 | ||||||||
Farré et al. [14] | 2017 | Catalonia | 88,195 | 77 (12) | 55.0% | 2.70% | 0.30% | 0.90% | 2.50% | 8.80% | ||
Anguita et al. [15] | 2008 | Spain | 1776 | 64 (12) | 55.9% | 6.80% | 1.30% | 5.50% | 8.00% | 16.1% | ||
40–49 | 50–59 | 60–69 | 70–79 | ≥80 | ||||||||
Cortina et al. [16] | 2001 | Asturias | 391 | 60 (13) | 53.6% | 5.00% | <1.00% | 2.00% | 5.00% | 13.0% | 18.0% | |
0–49 | 50–59 | 60–69 | 70–79 | 80–89 | ≥90 | |||||||
Ohlmeier et al. [17] | 2015 | Germany | 6,284,194 | 39 (21) | 48.2% | 1.70% | 0.10% | 1.28% | 3.88% | 10.8% | 25.9% | 45.7% |
19–54 | 55–64 | 65–74 | 75–84 | 85–99 | ||||||||
Parén et al. [18] | 2014 | Sweden | 144,925 | - | 48.9% | 1.99% | 0.13% | 1.06% | 3.20% | 9.23% | 20.4% | |
45–64 | 65–74 | ≥75 | ||||||||||
Murphy et al. [31] | 2004 | Scotland | 307,741 | - | 50.6% | 0.71% | 0.38% | 2.30% | 6.53% | |||
55–64 | 65–74 | 75–84 | ≥85 | |||||||||
Bleumink et al. [32] | 2004 | Rotterdam | 7983 | 70 (10) | 61.0% | 6.70% | - | 0.90% | 4.00% | 9.70% | 17.4% | |
25–49 | 50–59 | 60–69 | 70–79 | ≥80 | ||||||||
Ceia et al. [33] | 2002 | Portugal | 5434 | 68 (15) | 62.7% | 4.36% | 1.36% | 2.93% | 7.63% | 12.7% | 16.1% |
Study | Year of Publication | Study Population | Age, Years (SD) | Women, % | Type of Heart Failure | Geographical Area | Specialty | Reduced EF | NYHA Class II–IV |
---|---|---|---|---|---|---|---|---|---|
RICA [27] | 2017 | 1396 | 79 (8) | 54.0% | chronic | Spain | Internal medicine | 39.5% | 80.2% |
REDINSCOR [27] | 2017 | 2150 | 70 (10) | 31.0% | chronic | Spain | Cardiology | 79.6% | 100% ¹ |
BADAPIC [6] | 2010 | 4720 | 65 (12) | 29.0% | chronic | Spain | Cardiology | 63.4% | 100% ¹ |
INCA [7] | 2009 | 2161 | 71 (11) | 44.4% | chronic | Spain | Primary care and cardiology | 38.3% | 84.0% |
EPISERVE [28] | 2008 | 2249 | 72 (10) | 45.0% | - | Spain, except La Rioja | Primary care, cardiology, and internal medicine | 55.0% | 90.4% |
GALICAP [29] | 2007 | 1195 | 76 (10) | 52.1% | - | Galicia | Primary care | 38.6% | 81.5% |
Mean | 52.4% | 84.0% |
General Population (by Age Group) | Heart Failure Prevalence (by Age Group) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Total | 45–54 | 55–64 | 65–74 | Total | 45–54 | 55–64 | 65–74 | 75+ | ||
Autonomous Communities | 0.30% | 0.90% | 2.50% | 8.80% | ||||||
Andalucía | 3,895,025 | 1,341,487 | 1,093,149 | 770,187 | 690,202 | 93,855 | 4024 | 9838 | 19,255 | 60,738 |
Aragón | 674,882 | 207,355 | 180,224 | 136,185 | 151,118 | 18,947 | 622 | 1622 | 3405 | 13,298 |
Principado de Asturias | 589,263 | 164,027 | 161,384 | 131,949 | 131,903 | 16,851 | 492 | 1452 | 3299 | 11,607 |
Illes Balears | 529,589 | 194,110 | 145,007 | 103,545 | 86,927 | 12,126 | 582 | 1305 | 2589 | 7650 |
Canarias | 1,048,012 | 390,823 | 293,621 | 199,438 | 164,130 | 23,244 | 1172 | 2643 | 4986 | 14,443 |
Cantabria | 307,255 | 93,358 | 85,403 | 65,351 | 63,143 | 8239 | 280 | 769 | 1634 | 5557 |
Castilla y León | 1,347,618 | 376,632 | 361,698 | 275,863 | 333,425 | 40,623 | 1130 | 3255 | 6897 | 29,341 |
Castilla-La Mancha | 974,147 | 320,338 | 265,833 | 180,457 | 207,519 | 26,127 | 961 | 2392 | 4511 | 18,262 |
Catalunya | 3,593,591 | 1,188,206 | 946,935 | 738,057 | 720,393 | 93,933 | 3565 | 8522 | 18,451 | 63,395 |
Comunitat Valenciana | 2,437,743 | 799,940 | 658,274 | 508,440 | 471,089 | 62,491 | 2400 | 5924 | 12,711 | 41,456 |
Extremadura | 537,686 | 166,131 | 151,011 | 104,505 | 116,039 | 14,682 | 498 | 1359 | 2613 | 10,211 |
Galicia | 1,484,698 | 424,418 | 377,370 | 322,257 | 360,653 | 44,463 | 1273 | 3396 | 8056 | 31,737 |
Comunidad de Madrid | 3,099,482 | 1,074,013 | 826,152 | 609,975 | 589,342 | 77,769 | 3222 | 7435 | 15,249 | 51,862 |
Región de Murcia | 648,115 | 234,820 | 176,760 | 123,046 | 113,489 | 15,358 | 704 | 1591 | 3076 | 9987 |
Comunidad Foral de Navarra | 317,203 | 102,519 | 84,911 | 64,649 | 65,124 | 8419 | 308 | 764 | 1616 | 5731 |
País Vasco | 1,156,253 | 347,445 | 312,977 | 247,706 | 248,125 | 31,887 | 1042 | 2817 | 6193 | 21,835 |
La Rioja | 158,846 | 49,143 | 43,080 | 32,058 | 34,565 | 4378 | 147 | 388 | 801 | 3042 |
Ciudad Autónoma de Ceuta | 32,632 | 12,059 | 10,246 | 5676 | 4651 | 680 | 36 | 92 | 142 | 409 |
Ciudad Autónoma de Melilla | 30,008 | 11,057 | 9737 | 5077 | 4137 | 612 | 33 | 88 | 127 | 364 |
All Communities | 22,862,048 | 7,497,881 | 6,183,772 | 4,624,421 | 4,555,974 | 594,684 | 22,494 | 55,654 | 115,611 | 400,926 |
95% CI | 22,852,679–22,871,420 | 7,492,516–7,503,249 | 6,178,900–6,188,647 | 4,620,208–4,628,637 | 4,551,792–4,560,158 | 593,175–596,196 | 22,202–22,789 | 55,194–56,117 | 114,947–116,278 | 399,687–402,168 |
Heart Failure + Ejection Fraction ≤ 40% (by Age Group) | Heart Failure + Ejection Fraction ≤ 40% + NYHA Class II–IV (by Age Group) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Total | 45–54 | 55–64 | 65–74 | 75+ | Total | 45–54 | 55–64 | 65–74 | 75+ | |
Autonomous Communities | 52.4% | 52.4% | 52.4% | 52.4% | 84.0% | 84.0% | 84.0% | 84.0% | ||
Andalucía | 49,180 | 2109 | 5155 | 10,089 | 31,827 | 41,311 | 1771 | 4330 | 8475 | 26,734 |
Aragón | 9928 | 326 | 850 | 1784 | 6968 | 8340 | 274 | 714 | 1499 | 5853 |
Principado de Asturias | 8830 | 258 | 761 | 1729 | 6082 | 7417 | 217 | 639 | 1452 | 5109 |
Illes Balears | 6354 | 305 | 684 | 1356 | 4008 | 5337 | 256 | 574 | 1139 | 3367 |
Canarias | 12,180 | 614 | 1385 | 2613 | 7568 | 10,231 | 516 | 1163 | 2195 | 6357 |
Cantabria | 4317 | 147 | 403 | 856 | 2912 | 3627 | 123 | 338 | 719 | 2446 |
Castilla y León | 21,287 | 592 | 1706 | 3614 | 15,375 | 17,881 | 497 | 1433 | 3036 | 12,915 |
Castilla-La Mancha | 13,690 | 504 | 1254 | 2364 | 9569 | 11,500 | 423 | 1053 | 1986 | 8038 |
Catalunya | 49,221 | 1868 | 4466 | 9669 | 33,219 | 41,346 | 1569 | 3751 | 8122 | 27,904 |
Comunitat Valenciana | 32,745 | 1258 | 3104 | 6661 | 21,723 | 27,506 | 1056 | 2608 | 5595 | 18,247 |
Extremadura | 7693 | 261 | 712 | 1369 | 5351 | 6462 | 219 | 598 | 1150 | 4495 |
Galicia | 23,299 | 667 | 1780 | 4222 | 16,630 | 19,571 | 560 | 1495 | 3546 | 13,970 |
Comunidad de Madrid | 40,751 | 1688 | 3896 | 7991 | 27,176 | 34,231 | 1418 | 3273 | 6712 | 22,828 |
Región de Murcia | 8048 | 369 | 834 | 1612 | 5233 | 6760 | 310 | 700 | 1354 | 4396 |
Comunidad Foral de Navarra | 4411 | 161 | 400 | 847 | 3003 | 3706 | 135 | 336 | 711 | 2523 |
País Vasco | 16,709 | 546 | 1476 | 3245 | 11,442 | 14,035 | 459 | 1240 | 2726 | 9611 |
La Rioja | 2294 | 77 | 203 | 420 | 1594 | 1927 | 65 | 171 | 353 | 1339 |
Ciudad Autónoma de Ceuta | 356 | 19 | 48 | 74 | 214 | 299 | 16 | 41 | 62 | 180 |
Ciudad Autónoma de Melilla | 321 | 17 | 46 | 67 | 191 | 269 | 15 | 39 | 56 | 160 |
All Communities | 311,614 | 11,787 | 29,163 | 60,580 | 210,085 | 261,756 | 9901 | 24,497 | 50,887 | 176,471 |
95% CI | 310,522–312,709 | 11,576–12,001 | 28,830–29,499 | 60,100– 61,063 | 209,189–210,984 | 260,755–262,760 | 9708–10,097 | 24,192–24,805 | 50,447–51,330 | 175,650–177,295 |
HF + EF ≤ 40% + NYHA Class II–IV + GFR ≥ 30 (by Age Group) | |||||
---|---|---|---|---|---|
Total | 45–54 | 55–64 | 65–74 | 75+ | |
Autonomous Communities | 93.9% | 93.9% | 93.9% | 93.9% | |
Andalucía | 38,791 | 1663 | 4066 | 7958 | 25,104 |
Aragón | 7831 | 257 | 670 | 1407 | 5496 |
Principado de Asturias | 6965 | 203 | 600 | 1363 | 4797 |
Illes Balears | 5012 | 241 | 539 | 1070 | 3162 |
Canarias | 9607 | 485 | 1092 | 2061 | 5970 |
Cantabria | 3405 | 116 | 318 | 675 | 2297 |
Castilla y León | 16,790 | 467 | 1345 | 2850 | 12,127 |
Castilla-La Mancha | 10,798 | 397 | 989 | 1865 | 7548 |
Catalunya | 38,823 | 1473 | 3522 | 7626 | 26,202 |
Comunitat Valenciana | 25,828 | 992 | 2449 | 5254 | 17,134 |
Extremadura | 6068 | 206 | 562 | 1080 | 4220 |
Galicia | 18,377 | 526 | 1404 | 3330 | 13,117 |
Comunidad de Madrid | 32,143 | 1332 | 3073 | 6303 | 21,435 |
Región de Murcia | 6348 | 291 | 658 | 1271 | 4128 |
Comunidad Foral de Navarra | 3480 | 127 | 316 | 668 | 2369 |
País Vasco | 13,179 | 431 | 1164 | 2559 | 9025 |
La Rioja | 1810 | 61 | 160 | 331 | 1257 |
Ciudad Autónoma de Ceuta | 281 | 15 | 38 | 59 | 169 |
Ciudad Autónoma de Melilla | 253 | 14 | 36 | 52 | 150 |
All Communities | 245,789 | 9297 | 23,002 | 47,783 | 165,707 |
95% CI | 244,819–246,762 | 9,110–9,487 | 22,707–23,300 | 47,357–48,212 | 164,911–166,506 |
HF + EF ≤ 40% + NYHA Class II–IV + GFR ≥ 30 + Diabetes (by Age Group) | HF + EF ≤ 40% + NYHA Class II–IV + GFR ≥ 30 (No Diabetes) (by Age Group) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Total | 45–54 | 55–64 | 65–74 | 75+ | Total | 45–54 | 55–64 | 65–74 | 75+ | |
Autonomous Communities | 28.7% | 40.7% | 49.2% | 48.2% | 71.3% | 59.3% | 50.8% | 51.8% | ||
Andalucía | 18,157 | 478 | 1654 | 3914 | 12,111 | 20,634 | 1185 | 2412 | 4044 | 12,993 |
Aragón | 3690 | 74 | 273 | 692 | 2652 | 4141 | 183 | 398 | 715 | 2845 |
Principado de Asturias | 3288 | 58 | 244 | 671 | 2314 | 3677 | 145 | 356 | 693 | 2483 |
Illes Balears | 2340 | 69 | 219 | 526 | 1525 | 2672 | 172 | 320 | 544 | 1636 |
Canarias | 4477 | 139 | 444 | 1014 | 2880 | 5130 | 345 | 648 | 1047 | 3090 |
Cantabria | 1603 | 33 | 129 | 332 | 1108 | 1803 | 82 | 188 | 343 | 1189 |
Castilla y León | 7934 | 134 | 547 | 1402 | 5851 | 8856 | 333 | 798 | 1448 | 6277 |
Castilla-La Mancha | 5075 | 114 | 402 | 917 | 3641 | 5724 | 283 | 587 | 947 | 3906 |
Catalunya | 18,248 | 423 | 1433 | 3751 | 12,641 | 20,576 | 1050 | 2090 | 3875 | 13,561 |
Comunitat Valenciana | 12,131 | 285 | 996 | 2584 | 8266 | 13,697 | 707 | 1453 | 2670 | 8868 |
Extremadura | 2855 | 59 | 228 | 531 | 2036 | 3213 | 147 | 333 | 549 | 2184 |
Galicia | 8688 | 151 | 571 | 1638 | 6328 | 9689 | 375 | 833 | 1692 | 6789 |
Comunidad de Madrid | 15,074 | 383 | 1250 | 3100 | 10,341 | 17,069 | 949 | 1823 | 3203 | 11,094 |
Región de Murcia | 2968 | 84 | 267 | 625 | 1991 | 3380 | 207 | 390 | 646 | 2136 |
Comunidad Foral de Navarra | 1636 | 37 | 128 | 329 | 1143 | 1843 | 91 | 187 | 339 | 1226 |
País Vasco | 6210 | 124 | 473 | 1259 | 4,354 | 6969 | 307 | 691 | 1301 | 4671 |
La Rioja | 852 | 18 | 65 | 163 | 607 | 957 | 43 | 95 | 168 | 651 |
Ciudad Autónoma de Ceuta | 130 | 4 | 16 | 29 | 82 | 151 | 11 | 23 | 30 | 88 |
Ciudad Autónoma de Melilla | 117 | 4 | 15 | 26 | 73 | 136 | 10 | 21 | 27 | 78 |
All Communities | 115,473 | 2672 | 9355 | 23,503 | 79,943 | 130,316 | 6625 | 13,647 | 24,280 | 85,764 |
95% CI | 114,809–116,140 | 2573–2774 | 9167–9546 | 23,205–23,804 | 79,391–80,498 | 129,610–131,025 | 6467–6786 | 13,420–13,877 | 23,977–24,586 | 85,192–86,339 |
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Camps-Vilaró, A.; Delgado-Jiménez, J.F.; Farré, N.; Tizón-Marcos, H.; Álvarez-García, J.; Cinca, J.; Dégano, I.R.; Marrugat, J. Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria. J. Clin. Med. 2020, 9, 2089. https://doi.org/10.3390/jcm9072089
Camps-Vilaró A, Delgado-Jiménez JF, Farré N, Tizón-Marcos H, Álvarez-García J, Cinca J, Dégano IR, Marrugat J. Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria. Journal of Clinical Medicine. 2020; 9(7):2089. https://doi.org/10.3390/jcm9072089
Chicago/Turabian StyleCamps-Vilaró, Anna, Juan F. Delgado-Jiménez, Núria Farré, Helena Tizón-Marcos, Jesús Álvarez-García, Juan Cinca, Irene R. Dégano, and Jaume Marrugat. 2020. "Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria" Journal of Clinical Medicine 9, no. 7: 2089. https://doi.org/10.3390/jcm9072089
APA StyleCamps-Vilaró, A., Delgado-Jiménez, J. F., Farré, N., Tizón-Marcos, H., Álvarez-García, J., Cinca, J., Dégano, I. R., & Marrugat, J. (2020). Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria. Journal of Clinical Medicine, 9(7), 2089. https://doi.org/10.3390/jcm9072089