Prevalence, outcomes and costs of a contemporary, multinational population with heart failure

Anna Norhammar*, Johan Bodegard, Marc Vanderheyden, Navdeep Tangri, Avraham Karasik, Aldo Pietro Maggioni, Kari Anne Sveen, Tiago Taveira-Gomes, Manuel Botana, Lukas Hunziker, Marcus Thuresson, Amitava Banerjee, Johan Sundström, Andreas Bollmann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective Digital healthcare systems could provide insights into the global prevalence of heart failure (HF). We designed the CardioRenal and Metabolic disease (CaReMe) HF study to estimate the prevalence, key clinical adverse outcomes and costs of HF across 11 countries. Methods Individual level data from a contemporary cohort of 6 29 624 patients with diagnosed HF was obtained from digital healthcare systems in participating countries using a prespecified, common study plan, and summarised using a random effects meta-analysis. A broad definition of HF (any registered HF diagnosis) and a strict definition (history of hospitalisation for HF) were used. Event rates were reported per 100 patient years. Cumulative hospital care costs per patient were calculated for a period of up to 5 years. Results The prevalence of HF was 2.01% (95% CI 1.65 to 2.36) and 1.05% (0.85 to 1.25) according to the broad and strict definitions, respectively. In patients with HF (broad definition), mean age was 75.2 years (95% CI 74.0 to 76.4), 48.8% (40.9-56.8%) had ischaemic heart disease and 34.5% (29.4-39.6%) had diabetes. In 51 442 patients with a recorded ejection fraction (EF), 39.1% (30.3-47.8%) had a reduced, 18.8% (13.5-24.0%) had a mildly reduced and 42.1% (31.5-52.8%) had a preserved left ventricular EF. In 1 69 518 patients with recorded estimated glomerular filtration rate, 49% had chronic kidney disease (CKD) stages III-V. Event rates were highest for cardiorenal disease (HF or CKD) and all cause mortality (19.3 (95% CI 11.3 to 27.1) and 13.1 (11.1 to 15.1), respectively), and lower for myocardial infarction, stroke and peripheral artery disease. Hospital care costs were highest for cardiorenal diseases. Conclusions We estimate that 1-2% of the contemporary adult population has HF. These individuals are at significant risk of adverse outcomes and associated costs, predominantly driven by hospitalisations for HF or CKD. There is considerable public health potential in understanding the contemporary burden of HF and the importance of optimising its management.

Original languageEnglish
Pages (from-to)548-556
Number of pages9
Issue number7
StatePublished - 1 Apr 2023
Externally publishedYes


FundersFunder number
Fondazione ReS Ricerca e Salute, Casalecchio di Reno, Bologna
University of Bern
Horizon 2020 Framework Programme
European Federation of Pharmaceutical Industries and Associations
UK Research and Innovation116074
National Institute for Health and Care Research
British Medical Association


    • Epidemiology
    • Heart Failure


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