Trends in heart failure etiologies and comorbidities: a nationwide analysis of 700,000 individuals over two decades
D Lindholm, J SundstromAbstract
Background
Heart failure is the final common pathway of numerous different etiologies. Targeted prevention of heart failure requires detailed knowledge of underlying causes and associated conditions.
Purpose
To assess trends in comorbid conditions and etiologies in patients with heart failure (HF).
Methods
We used Swedish nationwide healthcare register data 2002-2023. A classification of heart failure etiologies proposed by the Global Burden of Disease study was applied, and the contribution of each condition relative to the total burden of comorbid conditions was calculated for each year. The prognostic relevance for each group was assessed by estimation of age- and sex-specific mortality rates using Poisson regression in a generalized additive model framework, with attained age added as a penalized spline.
Results
We identified 711,941 HF patients, 48% women. Figure 1 shows the relative contribution of each associated condition. Over time, there was a clear decrease in ischemic heart disease, but an increase in conditions of pressure overload and volume overload. HF on the basis of pulmonary disease, volume overload, or toxic cardiomyopathies were associated with a substantially elevated mortality relative to the overall HF cohort (Figure 2).
Conclusion
Over two decades, we observed a decrease in ischemic heart disease and increase in conditions of pressure and volume overload, such as hypertension and CKD, as conditions underpinning HF. This has important implications when prioritizing interventions for the primary prevention of HF.Fig 1:Trends in etiologies/comorbiditiesFor image description, please refer to the figure legend and surrounding text.Fig 2:Mortality by etiologyFor image description, please refer to the figure legend and surrounding text.