P2452The global burden of chronic heart failure

Abstract

Background: Chronic Heart Failure (CHF) one of the most common CVD globally, contributes over 10% of deaths in high income countries and 28% of deaths in low- and middle- income countries. Purpose: To quantify the prevalence of CHF in 45 countries in five regions worldwide in 2016, and forecast changes in prevalent cases based on a demographic forecast. To estimate the distribution of CHF in these countries according to the New York Heart Association (NYHA) classification system. Methods: Despite the magnitude of the public health problem posed by CHF, no single definition of heart failure has gained universal acceptance. We based our analysis on peer-reviewed population-based studies that defined CHF cases by (1) retrospective review of CHF diagnosis in medical records based on physical and radiographic examination, and/or measures of ventricular performance and exercise capacity, or (2) patients' self-reported histories of physician diagnosis. For countries where we did not identify robust population-based studies that met our disease definition, we developed a model to derive country-, age-, and gender-specific CHF prevalence estimates. Our model was based on years lived with disability ratios from the Global Burden of Disease study using the most common predisposing conditions reported for CHF (rheumatic, ischemic and hypertensive heart disease, cardiomyopathy, myocarditis, endocarditis). We estimate the lifetime prevalence of CHF in the North American, Latin American and Caribbean, European, Asia Pacific, Middle East and African regions. We used United Nations' population estimates to derive prevalent cases of CHF. We estimate the severity of CHF in each region using NYHA class using proportions from studies representative of low, middle and high income regions respectively. Results: We provide a snapshot and forecast of the worldwide prevalence indicating a notable rise in all countries. Our results suggest the highest prevalence is in North America (1,936 per 100,000) and lowest prevalence in Africa (248 per 100,000). Our forecast estimates the greatest 10-year growth in prevalent cases of CHF in Latin America and the Caribbean region (44%), and in Lower-income Asia-Pacific (37%), and the lowest in Europe at 22%. CHF severity by NYHA classification was inversely related to income. Lowerincome regions have a greater proportion of NHYA class III/IV CHF cases (62%) compared with higher-income countries which have a greater proportion of NYHA class I/II CHF cases (53%). Conclusion: The aging population will increase the burden of CHF worldwide, particularly in Latin America and Caribbean region and Africa. Burden of CHF will be accentuated in low-income countries where the severity, by NYHA class, is greater. However, we expect improvements in access to care, and therefore diagnosis and treatment, to decrease the severity of CHF in these regions.