The Global Burden of Heart Failure

While the world has been focusing on COVID-19, another pandemic has been growing in prevalence across the globe. Heart failure (HF) is on the rise and has been for some time. It currently affects around 26 million people worldwide and that figure is expected to go on rising.

Not only is HF a leading cause of death, particularly among the elderly population, the continuing treatment of HF survivors and those at risk also places an immense financial burden on the world’s health systems. 

In 2020, Giuseppe Lippi and Fabian Sanchis-Gomar aimed to provide an objective analysis of the worldwide epidemiological burden of HF. In their report, Global epidemiology and future trends of heart failure, they calculated the annual global expenditure on HF treatment to be US$ 346.17billion.

Why is heart failure prevalence increasing?

While HF therapies and preventions have seen significant advances, mortality and morbidity are still high and the quality of life for HF patients remains poor.

Ironically, the advances in HF treatment are part of the reason for its increasing prevalence. While the incidence of HF is largely stable, its prevalence is increasing with the ageing population, improved treatments and longer life expectancy.

Other factors are contributing. Comorbidities, including hypertension, diabetes and obesity, are on the rise, fuelled by the spread of poor lifestyle choices, such as smoking, drinking and the Western diet. Poor self-care has also been identified as a factor. One Swedish study found non-adherence to prescribed HF therapy in 22.1% of cases.

Defining the burden of heart failure

In the global population above 60 years of age, HF represents the biggest burden of all medical conditions. Lippi and Sanchis-Gomar found that the prevalence of HF had increased by 3.9% among that cohort over the previous 28 years, and by 4.5% among the very elderly.

They calculated that 9.91 million years are lost to disability caused by HF worldwide, representing a global crisis in both expenditure and quality of life. In Sweden, a national registry has reported that 66,318 and 59,535 premature life-years are lost due to HF in men and women respectively, compared to 55,364 and 64,533 due to cancer.

While treatment for HF patients is improving all the time, it costs, and as the prevalence increases with longer life expectancy, that cost continues to rise. An increase of 127% between 2012 and 2030 has been projected.

Global distribution of HF prevalence varies. In Europe, for example, it is somewhere between 1.5% and 2%, whereas South America reports 1%. In Asia it is apparently more common than in Europe, ranging from 1.3% in China to 6.7% in Malaysia. The quality of reporting varies from one geolocation to another, but in all cases, prevalence increases markedly with old age. As the world’s population ages and incidence remains stable at around 1%, prevalence will inevitably continue to rise.

The benefits of CNIBP

VitalStream™ is the world’s first wireless, wearable monitor for continuous blood pressure and advanced hemodynamics, having recently been granted FDA clearance for four new continuous hemodynamic parameters: cardiac output, stroke volume, heart rate variability, and left ventricular ejection time.

That means it combines the advantages of the two current standard methods of monitoring blood pressure – providing ICU level measurements continuously and non-invasively – with none of the drawbacks. Using a simple finger sensor connected to a wrist-mounted console, it can be fitted in under 30 seconds and remains with the patient wherever they go around the hospital, or even at home.

Because the measurements are continuous, it removes anomalies associated with whitecoat syndrome and picks up any significant change in blood pressure in real time, enabling doctors to respond to potentially severe events before they can develop.

Wireless connectivity integrates with electronic patient records, keeping a constant update on a patient’s condition. This makes it much quicker and easier for doctors to check on their patients wherever they are in the hospital, and know that they will be alerted immediately if any change is detected.

How to relieve the global burden of heart failure

HF is a significant global health problem that is in urgent need of a solution. Focusing solely on drugs and therapies will not relieve the burden; in fact, it will contribute to it through the need for more hospitalizations and prescriptions.

In order to reduce the prevalence of HF, we need to reduce the incidence in order to counterbalance the growth in the elderly population. That requires better education of the public, both in terms of lifestyle and diet to bring about a reduction in the comorbidities that lead to HF, and in adherence and self-care when under treatment for HF.

Increased use of telehealth and remote monitoring to help HF patients manage their own care will help to reduce the financial burden, both by alleviating the workload on healthcare professionals, avoiding unnecessary appointments and journey times, and catching changes in a patient’s condition early, thus enabling more effective intervention and preventing hospitalizations.

These measures, in tandem with further studies and phenotyping of different types of HF, will help us all to better understand this critical condition and how to prevent it.

Sources: 

https://amj.amegroups.com/article/view/5475/html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494150/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494150/#r4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494150/#r67

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941608/

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31737-9/fulltext