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Vol. 76. Issue 4.
Pages 272-274 (April 2023)
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Vol. 76. Issue 4.
Pages 272-274 (April 2023)
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Age and stabilization of admissions for heart failure in Spain (2006-2019). The beginning of the end of the “epidemic”?
Edad y estabilización de los ingresos por insuficiencia cardiaca en España (2006-2019). ¿El principio del fin de la «epidemia»?
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María Anguita Gámeza, Alberto Esteban Fernándezb, María García Márquezc, Náyade del Pradoc, Francisco J. Elola Somozac, Manuel Anguita Sánchezd,
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manuelanguita@secardiologia.es

Corresponding author.
a Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
b Servicio de Cardiología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
c Fundación IMAS, Madrid, Spain
d Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides para la Investigación Biomédica (IMIBIC), Universidad de Córdoba, Córdoba, Spain
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To the Editor,

Heart failure (HF) has been considered to be the great cardiovascular”epidemic“of the 21st century due to its high and increasing incidence and prevalence as well as its high mortality.1,2 One of the consequences of the enormous magnitude and severity of HF is the large number of hospital admissions, which are frequent despite treatment and lead to worsening prognosis, deterioration in the quality of life of patients and caregivers, and a high economic burden on the health care system.2,3 Indeed, several studies have shown that the admissions rate for HF in Spain since the 1990s has been steadily increasing4 and that this trend has continued in the early years of 21st century.5,6 The RECALCAR study of the Spanish Society of Cardiology6 has shown that one of the main reasons for the increasing incidence of HF admissions is population aging.

To further investigate this trend in Spain and the influence of advanced age on the number of HF hospitalizations, we studied the prevalence of admissions for HF episodes in Spanish Health Care System (HCS) hospitals. The data source was the minimum data set (MBDS) of the Ministry of Health. We selected all admissions of patients with a main diagnosis of HF between January 1, 2006 and December 31, 2019. These episodes were coded according to the International Classification of Diseases (ICD-9 until 2015; ICD-10 from 2016 onward).

From 2006 to 2009, there were 371 566 admissions for HF in Spanish HCS hospitals. However, from 2016 to 2019, there were 456 461 admissions, representing a significant increase of 22.8% (P <.001) despite underreporting in 2016 due to changes in the coding system. Nevertheless, when adjusted for age and sex (direct method), the admission rate (age- and sex-adjusted admissions per 100 000 population) was lower from 2017 to 2019 than from 2006 to 2015 (271 vs 286; P <.001). From 2006 to 2019, the percentage of patients aged at least 75 years admitted for HF significantly increased vs all HF admissions (from 69.9% in 2007 to 77.5% in 2019 [P <.001]). The number of admissions in this age group also significantly increased from 262 629 (2006-2009) to 351 589 (2016-2019). Indeed, this 33.8% increase was larger than the increase in total HF admissions (22.8%). Table 1 shows the trend (2006-2019) in the number of HF admissions, the age- and sex-adjusted rate of admissions per 100 000 population, the number and percentage of admissions of patients aged at least 75 years, and the number of admissions and age- and sex-adjusted rates of men and women aged at least 75 years. The overall incidence rate ratio is shown and also for the periods 2006 to 2015 and 2017 to 2019. Although there was an increasing trend in the number of admissions for HF, it can be seen that, from 2006 to 2019, the age- and sex-adjusted admission rate tended to decrease (IRR,0.98; 95% confidence interval [95%CI], 0.98-0.99; P <.001) and then flattened from 2017 to 2019 (IRR,1; 95%CI, 1-1; P <.001) (figure 1A). However, in that period, there was a significant increase in the number and percentage of HF admissions of patients aged at least 75 years (table 1). Table 1 also shows a decrease in HF admissions between 2015 and 2016, which was due to changes in the MDS coding system (ICD-9 until 2015; ICD-10 from 2016 onward). However, the slope representing the increase in the number of admissions remained similar before and after the change in coding (see figure 1B, joinpoint model).

Table 1.

Number of total HF admissions, age- and sex-adjusted admission rates per 100 000 population, and admissions and percentage of admissions of HF patients aged at least 75 years in Spain from 2006 to 2019.

Year  Total admissions for HF  Admission ratea  Admissions for HF, age ≥75 y
      Men  Men, age-adjusted  Women  Women, age-adjusted  Age-and sex-adjusted 
2006  84 881  263.2  57 948  68.3  22 371  1708  35 574  1681  1691 
2007  93 972  284.5  65 655  69.9  25 248  1850  40 406  1843  1845 
2008  95 073  280.3  67 997  71.5  26 590  1868  41 406  1823  1840 
2009  97 640  280.1  71 029  72.7  27 823  1880  43 204  1842  1856 
2010  103 305  287.6  76 330  73.9  30 124  1960  46 205  1906  1926 
2011  105 674  285.7  79 334  75.1  31 406  1969  47 936  1914  1935 
2012  110 318  291.4  83 900  76.1  33 277  2031  50 622  1977  1997 
2013  110 937  284.9  84 611  76.3  34 521  2055  50 090  1913  1967 
2014  114 626  286.9  87 362  76.2  35 063  2057  52 298  1968  2001 
2015  119 775  294.1  91 046  76.3  37 059  2135  54 347  2017  2062 
2016b  109 088  262.4  83 674  76.7  33 898  1904  49 773  1813  1848 
2017  114 571  270.8  87 961  76.8  36 075  1995  51 885  1864  1914 
2018  115 735  271.2  89 174  77.1  36 581  2000  52 591  1880  1926 
2019  117 068  271.3  90 780  77.5  37 247  2004  53 533  1894  1936 
Total  1 492 663  280.2  1 117 171  74.8  447 283  1972  669 870  1890  1921 
IRR (95%CI)  1.02 (1.02-1.03)  0.98 (0.98-0.99)  1.03 (1.02-1.04)  1.01 (1.01-1.01)  1.03 (1.03-1.04)  1.00 (1.00-1.01)  1.03 (1.02-1.03)  1.00 (1.00-1.01)  1.01 (1.00-1.01) 
P  <.001  <.001  <.001  <.001  <.001  <.001  <.001  <.001  .030 
IRR (95%CI), 2006-2015  1.03 (1.03-1.04)  1.00 (1.00-1.01)  1.04 (1.04-1.05)  1.01 (1.01-1.01)  1.05 (1.05-1.06)  1.02 (1.02-1.03)  1.04 (1.03-1.05)  1.02 (1.01-1.02)  1.01 (1.00-1.02) 
P  <.001  .007  <.001  <.001  <.001  <.001  <.001  <.001  .026 
IRR (95% CI), 2017-2019  1.01 (1.01-1.01)  1.00 (1.00-1.00)  1.02 (1.01-1.02)  1.00 (1.00-1.00)  1.01 (1.01-1.02)  1.00 (1.00-1.003)  1.02 (1.01-1.02)  1.01 (1.00-1.00)  1.00 (1.00-1.00) 
P  <.001  <.001  <.001  <.001  <.001  <.001  <.001  <.001  <.001 

HF, heart failure; 95%CI, 95% confidence interval; IRR, incidence rate ratio.

a

Admission rate: age- and sex-adjusted admissions rate per 100 000 population.

b

In 2016, there was underreporting due to changes in the coding system.

Figure 1.

A: trend in the adjusted admission rates of patients aged at least 75 years admitted for heart failure. In 2016, the age- and sex-adjusted admission rate decreased (underreporting); from 2017 onward, it remains at 271/100 000 population. B: joinpoint model of the number of admissions from 2006 to 2019; there was a decrease of 12.78% per year from 2015 to 2016. The annual percentage change and average annual percentage change are significant and equal (3.4), indicating that the trend did not change.

(0.16MB).

These results suggest 2 main points: a) in Spain, the age- and sex-adjusted admissions rate per 100 000 population has recently decreased; this is the first time this trend has been observed; and b) the percentage of admissions among patients aged at least 75 years has continued to increase. Therefore, it could be said that admissions for HF in Spain have stabilized, especially in patients younger than 75 years. This result could be related to advances in the treatment of HF, improvements in the organization of care management due to the implementation of HF programs, or a shift in the disease to older ages due to improvements in the health determinants of Spanish citizens. However, the HF”epidemic” continues to be of immense concern and places a huge burden on the Spanish HCS, especially because of the large population of older people in Spain.

FUNDING

This study was conducted with the help of an unconditional grant from Menarini (SEC RECALCAR Project). Menarini has not participated in any part of the preparation and submission process.

AUTHORS’ CONTRIBUTIONS

All the authors participated equally in the conception, design, analysis, writing, and revision of the article.

CONFLICTS OF INTEREST

None declared.

Acknowledgments

We would like to thank the Ministry of Health for its help in developing the RECALCAR project, with special thanks to the Instituto de Información Sanitaria.

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