Epidemiology of Heart Failure in Spain: Towards a More Global Perspective

To the Editor:

The PRICE¹ study reported a prevalence of heart failure of 6.8% in the Spanish population aged 45 years or more, a figure close to the 5% found in a previous study conducted in Asturias (Spain),² and that rose to 16% when only taking into account the population aged more than 75 years. These results confirm the striking increase in the number of cases of heart failure in the last 20 years in western countries, that has led to an ever-growing need for healthcare and an increased consumption of resources for its treatment.

However, to more accurately assess the total burden involved in a specific health problem, we need to know, in addition to prevalence, the number of hospitalizations that it generates. Thus, the Diagnosis-Related Group 127 includes heart failure and shock, which, at 2.68%, are the second most frequent causes of hospital admission in Spain and are the first cause among patients older than 65 years.³

From our standpoint, a measure that could complement the number of hospitalizations in the assessment of health costs would be the number of urgent cases, since on many occasions patient admission depends on the healthcare system resources in each center or region. For example, the observation areas that have recently become widespread within hospital emergency services (HES) are excellent places where, within 24 hours and without admission, disorders can be resolved that until a short time ago would have required admission.⁴ Thus, the EAHFE study⁵ (a cross-sectional descriptive study conducted in 10 Spanish HES and that collected information on 1017 consecutive heart failure patients treated over a 1-month period) showed that 70% of the patients were hospitalized (more than half in emergency service short-stay units) and, of the 30% discharged from the emergency service, 17% passed through these observation units. These data indicate the high healthcare burden that heart failure currently places on the HES. Another relevant aspect highlighted by the EAHFE study is that 1 of 4 patients with heart failure treated in the HES did not have a previous diagnosis of heart failure and in almost half the patients ventricular function remained unknown. On the other hand, if we compare comorbidity in the patient with heart failure in need of urgent treatment in the EAHFE study to that of the general population obtained in the PRICE study, we would see that in the first there is a greater percentage of hypertension, diabetes, ischemic heart disease, and systolic dysfunction, as well as a high percentage of patients with atrial fibrillation. An important aspect where both studies coincide is the enormous importance of age in this disease. The PRICE study¹ reported that the prevalence of heart failure in patients 65-74 years of age was half that in patients 75 years of age or more (8% in the first group and 16.1% in the second) and the EAHFE⁵ study reported that patients had a mean age of 77 (10) years.

All this reflects an attempt to explore the relevance of creating interdisciplinary groups made up of cardiologists, internists, geriatricians, primary care physicians, and emergency care physicians that would provide more integrated patient management, and which would lead to better understanding of this genuine 21st century epidemic⁶ and, in the end, to an improvement in patient care and healthcare systems in the context of heart failure.