To the Editor:
We would like to thank Martín et al for their interest in our article and their pertinent observations. Indeed, not only is the prevalence of heart failure increasing in Spain. as reported by the PRICE study1 and when compared to the work of Cortin et al2 in Asturias several years previously, but it is also important to emphasize that this disorder is the second most frequent cause of admission in Spain and the first cause among people more than 65 years of age. Thus, we are facing a problem of enormous and growing magnitude, that affects the vital prognosis of the patients who suffer from it, their quality of life and consumption of healthcare resources, with the consequent increase in economic costs.
The authors draw attention to other data of interest. The EAHFE study,3 a cross-sectional registry conducted in 10 Spanish hospitals on the characteristics of 1017 heart failure patients consecutively treated in the emergency services, found that 75% of the patients attending the emergency service for this problem had already been previously diagnosed with heart failure, although the state of ventricular function remained unknown in half of them. The PRICE study, that followed a totally different methodology, found that the prevalence of heart failure was 6.8%, but 5.8% of the total of the cases had also been previously diagnosed with heart failure. That is, de novo heart failure was diagnosed only in an additional 1% of people, in absolute terms. This means that, in relative terms, 85% of all the cases were already previously diagnosed and that only in 15% was there a new diagnosis of heart failure.
These data can be of great help when assessing the reliability of registries conducted at outpatient departments, emergency services, or after admitting patients with heart failure to hospital. Because most cases are diagnosed after examination in emergency services or after hospital admission, the characteristics of the patients found in these types of registries should be very similar to those of the general population of patients with heart failure. Finally, we fully agree with the authors for whom the integrated treatment and management of heart failure is extremely important. Correct treatment in emergency services can prevent a large number of admissions and improve the quality of life of patients.