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Burden of heart failure in Flemish general practices: a registry-based study in the Intego database
Miek Smeets1, Bert Vaes1,2, Pavlos Mamouris1
1Departement of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.
Insights
Heart failure (HF) stage C/D incidence and prevalence decreased, but earlier stages A and B increased. Despite better cardiovascular treatment, rising comorbidities in HF patients present ongoing challenges.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Heart failure (HF) remains a significant public health concern.
- Understanding trends in HF stages and associated factors is crucial for effective management.
- Previous studies have not fully elucidated long-term trends in HF stages A-C/D within primary care settings.
Purpose of the Study:
- To assess the prevalence and incidence of heart failure (HF) stages A to C/D and their evolution over 16 years.
- To investigate trends in comorbidities and cardiovascular (CV) treatment in patients with HF during the same period.
Main Methods:
- A registry-based study utilizing data from the Intego morbidity registration network in Flanders, Belgium.
- Inclusion of 165,796 unique patients aged 45 years and older between 2000 and 2015.
- Analysis of age-standardised prevalence and incidence rates, comorbidity profiles, and cardiovascular medication trends using joint-point regression.
Main Results:
- A downward trend in the incidence and prevalence of HF stage C/D was observed.
- The prevalence and incidence of HF stages A and B showed an increasing trend.
- Comorbidity burden in incident HF cases increased significantly (p<0.001), while cardiovascular medication use (RAS blockade, beta-blockers, statins) sharply increased from 2000-2008.
Conclusions:
- While advanced HF (stage C/D) shows a slight decline likely due to improved CV treatment, the rising incidence of early HF stages (A and B) is concerning.
- The increasing prevalence of early HF stages, coupled with a growing burden of comorbidities, highlights persistent challenges in managing heart health.
- Continued monitoring and proactive interventions targeting risk factors are essential to mitigate the future impact of heart failure.
Objectives:
To assess the prevalence and incidence of heart failure (HF) stages A to C/D and their evolution over a 16-year period. Additionally, trends in comorbidities and cardiovascular (CV) treatment in patients with HF were studied in the same period.
Design:
Registry-based study.
Setting:
Primary care, Flanders, Belgium.
Participants:
Data were obtained from Intego, a morbidity registration network in which 111 general practitioners of 48 practices collaborate. In the study period between 2000 and 2015, data from 165 796 unique patients aged 45 years and older were available.
Outcome Measures:
Prevalence and incidence were calculated for HF stage A, B and C/D by gender. Additionally, the trend in age-standardised prevalence and incidence rates between 2000 and 2015 was analysed with joint-point regression. The same model was used to study trends in comorbidity profiles in incident HF cases and trends in cardiovascular medication in prevalent HF cases.
Results:
We found a downward trend in the incidence and prevalence of HF stage C/D in Flemish general practice between 2000 and 2015, whereas the prevalence and incidence of stage A and B increased. The burden of comorbidities in incident HF cases increased during the study period, as shown by an increasing disease count (p<0.001). The prescription of cardiovascular medication such as renin-angiotensin-aldosterone system blockade, β-blockers and statins showed a sharp increase in the first part of the study period (2000-2008).
Conclusion:
Age-standardised incidence and prevalence of HF stage C/D showed a slightly downward trend over the past 16 years, probably due to the sharp increase in cardiovascular treatment. However, the increasing age-standardised incidence and prevalence of stage A and B, as precursors of symptomatic HF, together with a rising comorbid burden, highlights the challenges we are still facing.
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