Publish in this journal
Journal Information
Vol. 73. Issue 12.
Pages 1075-1077 (December 2020)
Vol. 73. Issue 12.
Pages 1075-1077 (December 2020)
Scientific letter
Full text access
Temporal trends in hospitalizations and in-hospital mortality in heart failure in Spain 2003-2015: differences between autonomous communities
Tendencias temporales en ingresos y mortalidad hospitalaria por insuficiencia cardiaca en España, 2003-2015: diferencias por comunidades autónomas
Visits
...
Manuel Anguita Sáncheza,b,
Corresponding author
manuelanguita@secardiologia.es

Corresponding author:
, Juan Luis Bonilla Palomasc, María García Márquezd, José Luis Bernal Sobrinod,e, Cristina Fernández Pérezc,f,g, Francisco Javier Elola Somozad
a Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
b Servicio de Cardiología, Hospital Quirón Salud, Córdoba, Spain
c Servicio de Cardiología, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain
d Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
e Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
f Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain
g Departamento de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Tables (1)
Table 1. Rates of age- and sex-weighted hospital attendance for HF for every 100 000 population between 2003 and 2015 in the different autonomous communities (A) and changes in the risk-standardized mortality ratios in the different autonomous communities in Spain between 2003 and 2015 (B)
Full Text
To the Editor,

Heart failure (HF) is a syndrome whose already high prevalence and incidence have increased in recent years. Although there are various HF-related registries in Spain,1,2 few provide an overall picture, with most data being derived from specialized hospitals or units, with the possible associated biases. To study temporal trends in hospitalization and in-hospital mortality due to HF in Spain as a whole and according to autonomous community (AC), we have used the Spanish hospital Minimum Data Set (MDS)3 to analyze all discharges with the principal diagnosis of HF recorded in Spanish public hospitals between 2003 and 2015.3 The study population was based on hospitalization episodes recorded in the MDS between January 1, 2003, and December 31, 2015. The analysis included patients with the principal diagnosis of HF according to ICD-9-CM (International Classification of Diseases, Ninth Revision) codes 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, and 428 and considered hospital attendance (annual rate of hospital admissions for HF per 100 000 population) and in-hospital mortality. The rate of hospital attendance was adjusted by age and sex. The risk-standardized mortality ratio (RSMR) was calculated as described recently.4,5 Quantitative variables were compared using the t test and analysis of variance (ANOVA); discrete variables were compared with the chi-square test. P values <.05 were considered significant.

Between 2003 and 2015, 4 946 702 admissions due to cardiovascular diseases were recorded; 1 363 022 were for HF (27.5%). The changes over time in the total number of admissions for HF are illustrated in figure 1A and showed a progressive increase from 2003 to 2015 (P <.001). The rate of age- and sex-weighted hospital attendance increased from 229.7 to 269.6/100 000 population (P <.001) (table 1A). This rate significantly differed among ACs (P <.001) (table 1A). The communities with the lowest rates of hospital attendance were the Canary Islands, Chartered Community of Navarre, and Catalonia (table 1A); the highest rates were seen in Principality of Asturias, Community of Madrid, and Aragon. The difference between the communities with the highest and lowest rates of hospital attendance was 259.3/100 000 population (396.3 in Asturias vs 137.0 in the Canary Islands). All of the ACs, except Catalonia, showed a significant increase in the rate of hospital attendance for HF from 2003 to 2015 (table 1A and figure 1B).

Figure 1.

Temporal trends in heart failure in Spain from 2003 to 2015. A: changes in the number of admissions per year with the principal diagnosis of heart failure. B: rates of hospital attendance weighted by age and sex for every 100 000 population in the different autonomous communities. C: graphical representation of the in-hospital mortality rates adjusted by risk in the different autonomous communities. D: changes in the ratios of in-hospital mortality adjusted by risk in the different autonomous communities.

(0.39MB).
Table 1.

Rates of age- and sex-weighted hospital attendance for HF for every 100 000 population between 2003 and 2015 in the different autonomous communities (A) and changes in the risk-standardized mortality ratios in the different autonomous communities in Spain between 2003 and 2015 (B)

2003  2004  2005  2006  2007  2008  2009  2010  2011  2012  2013  2014  2015  2003-2015 
Andalusiaa  197.6  196.7  208.7  200.9  222.8  212.2  207.0  206.5  205.9  203.2  210.3  212.6  217.0  208.0 
Aragona  214.2  260.6  286.2  304.1  314.6  303.4  294.3  321.8  324.9  314.5  352.7  346.0  376.7  309.4 
Principality of Asturiasa  378.4  361.2  382.0  381.9  413.3  437.6  436.8  395.5  364.2  389.1  405.0  399.9  406.6  396.3 
Balearic Islandsa  174.1  175.9  199.8  185.8  193.4  210.3  198.5  208.2  213.3  226.9  219.4  219.8  197.6  202.7 
Canary Islandsa  123.9  131.7  138.5  150.3  141.9  131.7  146.2  135.5  141.1  140.1  130.1  130.9  138.5  137.0 
Cantabriaa  305.9  315.5  322.8  311.7  321.0  284.8  305.5  271.5  285.0  296.3  274.3  289.2  306.6  299.0 
Castile and Leóna  249.1  313.6  332.0  353.7  389.5  392.5  382.0  376.7  345.6  356.4  351.8  362.0  358.0  351.3 
Castile-La Manchaa  234.8  244.7  247.2  241.1  260.4  278.9  273.9  280.8  282.9  278.6  274.0  284.7  316.8  270.0 
Cataloniab  250.3  256.3  255.8  245.2  264.5  266.4  254.7  261.8  266.7  270.5  242.0  232.6  235.8  261.9 
Valencian Communitya  207.3  218.7  213.6  210.6  222.0  230.1  233.2  244.4  242.1  257.5  258.7  236.4  268.9  234.7 
Extremaduraa  286.0  322.6  332.9  320.8  310.3  287.4  316.2  335.0  305.2  317.6  299.2  304.1  354.1  314.8 
Galiciaa  277.6  301.3  301.1  285.1  288.1  290.2  291.3  314.0  322.1  321.9  308.8  331.0  329.1  304.8 
Community of Madrida  242.1  253.4  277.3  269.4  281.4  262.6  264.7  274.7  266.4  272.8  266.5  273.0  275.7  267.9 
Region of Murciaa  169.8  172.6  184.2  194.1  221.2  227.5  215.6  221.6  221.6  231.2  251.3  237.4  235.3  214.9 
Chartered Community of Navarrea  191.0  197.7  224.3  230.3  259.6  256.0  214.0  221.3  230.9  237.5  229.2  227.8  223.2  226.7 
Basque Countrya  243.8  266.9  251.3  246.9  312.9  308.6  304.7  310.1  313.9  315.8  305.0  300.1  317.1  292.2 
La Riojaa  348.1  356.6  403.5  336.6  410.9  381.8  342.0  383.0  387.0  398.8  378.8  420.8  395.9  380.0 
Spaina  229.7  242.8  251.4  247.0  265.6  270.0  259.3  264.4  262.1  266.7  261.3  259.3  269.6  258.0 
RSMR per y                           
  2003  2004  2005  2006  2007  2008  2009  2010  2011  2012  2013  2014  2015  2003-2015 
Andalusia  14.56  13.87  15.18  13.98  14.55  14.27  14.16  14.19  14.67  14.34  14.14  13.84  15.03  14.37 
Aragon  9.70  9.36  10.41  9.33  9.22  9.30  9.49  9.09  10.27  10.55  9.93  9.72  10.26  9.77 
Principality of Asturias  9.78  9.80  10.11  9.52  9.62  9.00  9.12  9.32  9.41  9.54  9.39  9.45  9.90  9.52 
Balearic Islands  10.03  9.40  9.87  9.43  9.21  9.42  9.45  9.78  9.10  9.08  9.07  8.75  9.47  9.35 
Canary Islands  12.22  11.92  11.89  10.38  10.94  11.41  11.52  11.18  11.60  12.14  11.19  11.19  13.04  11.60 
Cantabria  10.70  10.42  11.11  10.06  10.40  10.91  10.41  10.86  10.62  10.93  10.19  10.19  10.92  10.59 
Castile and León  11.66  11.02  12.03  10.02  10.36  10.30  10.03  10.04  10.09  10.53  10.25  9.86  10.55  10.44 
Castile-La Mancha  10.59  10.38  10.81  10.21  10.72  10.24  9.80  9.95  10.10  10.52  10.18  10.39  11.01  10.38 
Catalonia  9.76  9.16  9.63  8.78  9.14  9.23  9.43  9.70  9.83  10.16  9.66  9.41  10.12  9.56 
Valencian Community  11.05  10.43  10.96  10.31  10.64  10.79  10.81  10.37  10.51  10.68  10.58  10.65  11.50  10.72 
Extremadura  11.89  11.47  11.86  11.05  11.34  11.29  11.04  11.29  11.32  11.78  10.68  10.89  11.41  11.32 
Galicia  10.15  9.87  10.06  9.36  9.66  9.90  9.80  9.99  10.23  10.57  10.03  10.17  10.84  10.08 
Community of Madrid  9.20  8.67  8.74  7.60  8.13  7.68  7.60  7.64  7.87  8.14  7.56  7.49  8.03  7.97 
Region of Murcia  10.48  9.51  10.22  8.96  9.29  9.32  9.46  9.28  9.56  10.16  9.62  9.50  9.88  9.62 
Chartered Community of Navarre  8.76  8.54  9.38  9.37  9.02  8.78  9.36  9.31  9.55  9.68  9.19  9.97  8.89  9.24 
Basque Country  9.23  8.64  9.00  8.35  8.95  8.97  8.95  9.01  9.02  9.04  8.69  8.34  9.06  8.87 
La Rioja  7.85  7.57  8.38  7.69  7.70  8.29  8.07  8.68  8.41  8.36  8.25  7.43  8.40  8.10 
Spain  10.84  10.53  11.06  10.19  10.52  10.51  10.38  10.37  10.48  10.64  10.22  10.14  10.80  10.54 

RSMR, risk-standardized mortality ratio.

a

P < .001.

b

P=.107 (not significant).

RSMR tendencies without significant differences for any community or Spain as a whole between 2003 and 2015.

In-hospital mortality was significantly different among the ACs throughout the 2003 to 2015 study period (table 1B and figure 1C) (P <.001), with highly marked differences in the RSMR, from 7.97% in the Community of Madrid to 14.35% in Andalusia (national average, 10.54%). The in-hospital mortality was unchanged between 2003 and 2015 (P=.664) (table 1B). As seen with the national average, there were no significant changes in mortality in any of the communities between 2003 and 2015 (table 1B and figure 1D). Every year, mortality was higher in Andalusia, the Canary Islands, Extremadura, and Castile and León and lower in Community of Madrid, Chartered Community of Navarre, La Rioja, and the Basque Country, with intermediate annual rates in the other regions.

There were also no differences in the RSMR according to sex, with similar mortality in men and women in both Spain as a whole (men, 10.39%; women, 10.32%; P=.517) and in the different ACs, without changes from 2003 to 2015. In men, the RSMR decreased from 10.90% in 2003 to 10.78% in 2015 (P=.816); in the same period, it increased from 10.78% to 10.82% in women (P=.517). Although the rate of hospital attendance was generally lower in women during the study period, the tendency for an increase in this rate was similar in the 2 sexes (P=.563).

In conclusion, this study has revealed a significant increase in the number of admissions and in the rate of hospital attendance for HF between 2003 and 2015 in Spain and in almost all ACs. In addition, in-hospital mortality adjusted by risk (RSMR) was largely unchanged in the study period and remains at about 10% in Spain. These data confirm the tendency shown by older studies5,6 and indicate an ever-increasing impact of HF. The rate of hospital attendance varied significantly among the different ACs, similar to in-hospital mortality. With the limitations inherent to the data source, the hospital MDS, which is dependent on the quality of the disease coding but is used throughout Spain, we believe that our data shed light on a highly impactful problem, that of the continuous increase in HF burden in Spain and of the major differences among ACs. It is essential to identify explanations for these differences though research that relates these data to variables such as socioeconomic factors, geographical dispersion, health care parameters (management systems, health care investment), the existence of HF programs, discharge services, and type of hospital.

FUNDING

This work was made possible by an unconditional grant from Menarini.

Acknowledgments

We thank the Spanish Ministry of Health and the Institute of Health Information of the Spanish National Health System for the resources provided to the Spanish Society of Cardiology to undertake the RECALCAR project.

References
[1]
J.B. López-Mesa, J.M. Andrés de Llano, L. López-Fernández, et al.
Evolución de las tasas de hospitalización y mortalidad hospitalaria por enfermedades cardiovasculares agudas en Castilla y León, 2001-2015.
Rev Esp Cardiol., 71 (2018), pp. 95-104
[2]
M. Jiménez-Navarro, J. Gómez-Doblas, E. Molero, et al.
Heart failure mortality in Spain: is there an andalusian paradox?.
Rev Clin Esp., 206 (2006), pp. 276-277
[3]
Registro de altas de hospitalización: CMBD del Sistema Nacional de Salud. Glosario de términos y definiciones. Portal estadístico del SNS [updated Sep 2016]. p. 5-6. Available from: http://pestadistico.inteligenciadegestion.mscbs.es/publicoSNS/comun/DescargaDocumento.aspx?IdNodo=6415. Accessed 21 May 20.
[4]
V. Bertomeu, A. Cequier, J.L. Bernal, et al.
In-hospital mortality due to acute myocardial infarction. Relevance of type of hospital and care provided. RECALCAR study.
Rev Esp Cardiol., 66 (2013), pp. 935-942
[5]
P. Martínez-Santos, R. Bover, A. Esteban, et al.
Mortalidad hospitalaria y reingresos por insuficiencia cardiaca en España.
Un estudio de los episodios índice y los reingresos por causas cardiacas a los 30 días y al año. Rev Esp Cardiol., 72 (2019), pp. 988-990
[6]
C. Brotons, I. Moral, A. Ribera, et al.
Tendencias de la morbimortalidad por insuficiencia cardiaca en Cataluña.
Rev Esp Cardiol., 51 (1998), pp. 972-976
Idiomas
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

View newsletter history
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?