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Heart failure burden in Kazakhstan among adults: data from Unified National Electronic Healthcare System 2014-19
Gulnur Zhakhina1, Arnur Gusmanov1, Yesbolat Sakko1
1Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan.
Insights
Heart failure (HF) is a growing global health issue. In Kazakhstan, HF incidence declined, but mortality nearly tripled, highlighting a critical need for improved management and prevention strategies, especially for the elderly.
Area of Science:
- Cardiovascular Epidemiology
- Public Health
- Gerontology
Background:
- Heart failure (HF) presents a significant and escalating global healthcare challenge, with millions affected worldwide.
- Kazakhstan, the largest Central Asian nation, faces a substantial burden from HF, necessitating focused epidemiological research.
- Understanding HF's impact within specific populations is crucial for developing targeted public health interventions.
Purpose of the Study:
- To investigate the epidemiology of heart failure (HF) in the adult population of Kazakhstan.
- To analyze trends in HF incidence, mortality, and associated risk factors.
- To quantify the burden of HF in terms of disability-adjusted life years (DALYs) and premature death.
Main Methods:
- Retrospective analysis of electronic health records from Kazakhstan's Unified National Electronic Health System (2014-2019).
- Inclusion of 526,766 adult individuals diagnosed with HF.
- Statistical analysis of demographic data, comorbidities, mortality rates, and DALYs.
Main Results:
- The HF cohort comprised 54% women and 46% men, with 87% aged 50+.
- Hypertension (46%), cerebrovascular diseases (32%), and atherosclerotic heart disease (23%) were the most common comorbidities.
- While HF incidence decreased, all-cause mortality per million population nearly tripled (356 to 975) between 2014 and 2019.
- 14% of the HF cohort (71,591 patients) died during the study period.
- HF resulted in 2,364,789.8 DALYs in 2019, with premature death accounting for 1,337,578.9 years of life lost.
- Males faced a higher mortality risk (HR=1.24). History of acute myocardial infarction (HR=1.69) and diabetes (HR=1.14) significantly increased death risk.
Conclusions:
- Despite a declining incidence, heart failure poses a severe and increasing mortality risk in Kazakhstan.
- Urgent implementation of enhanced disease management systems and preventive strategies for the elderly population is essential.
- Further research into specific interventions is needed to mitigate the growing burden of heart failure in Kazakhstan.
Abstract:
Heart failure (HF) is a complex clinical syndrome with significant mortality risks, causing an increasing healthcare burden. Globally, 64.3 million prevalent cases were estimated in 2017. This research examines HF epidemiology in the adult population in Kazakhstan, the largest country in Central Asia. The retrospective analysis was performed on data from the Unified National Electronic Health System, involving 526 766 individuals registered with HF between 2014 and 2019. In the cohort, women accounted for 54% and men for 46%, and the majority (87%) were aged 50 or above. The most prevalent comorbid conditions were hypertension (46%), cerebrovascular diseases (32%), and atherosclerotic heart disease (23%). While the incidence rate declined over the observation period, the all-cause mortality rate almost tripled from 356 to 975 people per million population during the observation period. Of the cohort, 14% of the patients (71 591) were recorded as deceased. In 2019, HF in Kazakhstan resulted in the loss of 2364789.8 disability-adjusted life years. Premature death accounted for a major portion, with 1337578.9 years of life lost. Males have a higher risk of death compared to females [hazard ratio (HR) = 1.24, 95% confidence interval (CI): 1.23-1.26]. History of acute myocardial infarction increases the risk of death by 69% (HR = 1.69, 95% CI: 1.67-1.73) and diabetes by 14% (HR = 1.14, 95% CI: 1.12-1.16) after adjustment for other variables. This research evaluated the burden and disability-adjusted life years of HF in Kazakhstan. The results show that more effective disease management systems and preventive measures for the elderly are needed.
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