The epidemiology of heart failure in Australia

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Abstract

Background

The epidemiology of heart failure is poorly understood. Australia has one of the highest rates of cardiovascular disease in the world with heart failure representing a large proportion of this group, yet there is minimal data on the incidence or prevalence.

Aims

To determine the epidemiological impact of heart failure in Australia by assessing mortality and morbidity data.

Methods

Data were obtained from National and State health organisations in terms of morbidity and mortality of heart failure. Data were obtained from several sources so as to provide a comprehensive picture of the available epidemiological data on heart failure.

Results

The mortality rates associated with heart failure have been decreasing substantially over the last 20 years. However, there appears to be a stabilisation of heart failure presentations over the last decade, both nationally and in the state of New South Wales. Extrapolation of the data to assess prevalence of heart failure in the community was not possible.

Conclusions

Currently, mortality rates for heart failure are decreasing in Australia, while there does not appear to be any real increase in the numbers of patients admitted to hospital with a subsequent diagnosis of heart failure over a 10 year period.

Introduction

The epidemiology of heart failure remains inadequately studied. Despite a recent significant decline, Australia still has one of the highest rates of cardiovascular disease in the world, with heart failure representing a sizeable proportion of this group. Even though there are limited data on the epidemiology of heart failure, reports highlight that an aging population combined with improved survival after myocardial infarction provides the perfect setting for a huge heart failure epidemic in Australia within the next two decades [1], [2], [3], [4], [5], [6]. This is based on data from other countries where heart failure has emerged as a major public health problem [7], [8], [9], [10], [11]. In the United States and Europe, heart failure is the most common principal diagnosis among hospitalised adults aged 65 years and older and is a co-morbid disorder associated with many other conditions [12], [13], [14], [15]. Moreover, in the United States almost 5 million people (∼ 2% of the population) have heart failure with 500,000 new incident cases diagnosed every year [16], [17], [18]. Furthermore, the estimated cost of in-patient care, out-of-hospital expenditure, and management of individuals with heart failure in the United States exceeds US$20 billion annually [12], [13], [18].

However, the suggestion of a heart failure epidemic in Australia is not based on locally sourced incidence or prevalence data. The majority of current information on the epidemiology of heart failure is based on extrapolations from overseas studies [19], [20], [21], [22], [23], [24], [25]. Indeed, although these overseas studies consistently report increasing numbers of heart failure presentations, it would not be wise to generalize this to the Australian population without local evidence of a similar effect. We, therefore, obtained mortality and morbidity data to establish recent local data on the impact of heart failure in Australia.

Section snippets

Definition of heart failure/congestive heart failure

Heart failure occurs when the heart is unable to pump blood adequately to meet the metabolic needs of the body. It is a clinical syndrome and can result from a number of different causes. Symptoms of lassitude and/or dyspnoea at rest or low levels of physical activity are commonly encountered. Subdivision on pathophysiological mechanisms such as right/left heart failure, ischaemic/nonischaemic failure, systolic/diastolic failure – as examples – are important clinically but for the purposes of

Mortality

Overall, there appears to be a substantial decline in the mortality for heart failure over the last 20 years in Australia (Fig. 1). This trend occurs for both males and females with the mortality gap between the genders reducing over time. This same trend occurs for New South Wales, Victoria, Queensland, South Australia, Western Australia, Tasmania, and the Australian Capital Territory (data not shown). However, some states show recent increases in heart failure mortality, these include

Discussion

Improvement in lowering the incidence and mortality in ischaemic heart disease has been one of medical success stories of the past two decades. Preventative measures such as improved control of hyperlipidaemia, diabetes and hypertension, combined with impressive gains in the treatment of coronary artery disease, have led to a sizable proportion of the population who would have succumbed to the disease living longer, active lives. Amongst these survivors would be a cohort in whom residual heart

Acknowledgements

We would like to thank Dr Greg Stewart and New South Wales Health for giving us permission to use the NSW in-patient statistics. We would like to thank Ms Jill Kaldor from the Centre for Epidemiology and Research, NSW Department of Health for checking the data and producing the figures.

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