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The Heart Failure Association Atlas: Heart Failure Epidemiology and Management Statistics 2019
Petar M Seferović1,2, Panagiotis Vardas3,4, Ewa A Jankowska5
1Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Insights
The Heart Failure Association (HFA) Atlas reveals significant variations in heart failure (HF) prevalence, treatment resources, and data quality across European countries. These findings highlight the need for standardized HF statistics to address care inequalities.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) initiated the HFA Atlas to comprehensively assess heart failure (HF) epidemiology.
- The study aimed to describe HF prevalence, resource availability, guideline-directed medical therapy (GDMT) reimbursement, and National Heart Failure Societies' (NHFS) activities within ESC member nations.
Purpose of the Study:
- To provide a contemporary overview of heart failure (HF) epidemiology across ESC member countries.
- To evaluate the availability of diagnostic and management resources for HF.
- To assess the reimbursement status of guideline-directed medical therapy (GDMT) and the structure of national HF organizations.
Main Methods:
- A survey was conducted in 2018-2019 across 42 ESC member countries.
- Data on HF incidence, prevalence, hospitalizations, length of stay, resources, GDMT reimbursement, and NHFS activities were collected.
- Data quality varied significantly among participating countries.
Main Results:
- Median HF incidence was 3.20 cases per 1000 person-years; median prevalence was 17.20 cases per 1000 people.
- Significant disparities were observed in HF burden and hospitalizations across countries.
- High-income countries generally possessed more HF diagnostic and management resources than middle-income countries.
- Reimbursement for newer GDMTs like sacubitril/valsartan was often limited.
Conclusions:
- The HFA Atlas demonstrates substantial heterogeneity in HF disease burden, management resources, and data quality across ESC countries.
- There is a clear need for systematic HF data collection to quantify and address disparities in care.
- Standardized approaches are essential for improving HF management and outcomes globally.
Aims:
The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) developed the HFA Atlas to provide a contemporary description of heart failure (HF) epidemiology, resources, reimbursement of guideline-directed medical therapy (GDMT) and activities of the National Heart Failure Societies (NHFS) in ESC member countries.
Methods And Results:
The HFA Atlas survey was conducted in 2018-2019 in 42 ESC countries. The quality and completeness of source data varied across countries. The median incidence of HF was 3.20 [interquartile range (IQR) 2.66-4.17] cases per 1000 person-years, ranging from ≤2 in Italy and Denmark to >6 in Germany. The median HF prevalence was 17.20 (IQR 14.30-21) cases per 1000 people, ranging from ≤12 in Greece and Spain to >30 in Lithuania and Germany. The median number of HF hospitalizations was 2671 (IQR 1771-4317) per million people annually, ranging from <1000 in Latvia and North Macedonia to >6000 in Romania, Germany and Norway. The median length of hospital stay for an admission with HF was 8.50 (IQR 7.38-10) days. Diagnostic and management resources for HF varied, with high-income ESC member countries having substantially more resources compared with middle-income countries. The median number of hospitals with dedicated HF centres was 1.16 (IQR 0.51-2.97) per million people, ranging from <0.10 in Russian Federation and Ukraine to >7 in Norway and Italy. Nearly all countries reported full or partial reimbursement of standard GDMT, except ivabradine and sacubitril/valsartan. Almost all countries reported having NHFS or working groups and nearly half had HF patient organizations.
Conclusions:
The first report from the HFA Atlas has shown considerable heterogeneity in HF disease burden, the resources available for its management and data quality across ESC member countries. The findings emphasize the need for a systematic approach to the capture of HF statistics so that inequalities and improvements in care may be quantified and addressed.
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