Projects / Programmes
Heart failure epidemiology in Slovenia: prevalence, hospitalizations and mortality
| Code |
Science |
Field |
Subfield |
| 3.06.00 |
Medical sciences |
Cardiovascular system |
|
| Code |
Science |
Field |
| B530 |
Biomedical sciences |
Cardiovascular system |
| Code |
Science |
Field |
| 3.02 |
Medical and Health Sciences |
Clinical medicine |
Heart failure, hospitalization, prognosis, prevalence.
Researchers (9)
Organisations (3)
Abstract
Heart failure is associated with high mortality frequent hospitalizations, and high management costs. According to recent reports from developed countries, there is trend of reduction in hospitalization rates, yet heart failure remains the leading cause of hospitalization in elderly. In general, 1-2% prevalence is estimated, which increases with age. For Slovenia, epidemiological data is limited to regional hospitalization analyses and short observational periods whilst there is no information about prevalence.
We aim to obtain relevant epidemiological information about epidemiological burden of heart failure in Slovenia. These data should enable us to perform complex analysis and to plan clinical as well as health policy interventions for better management of heart failure. Additionally, we will be first to test the new criteria for diagnosis of diastolic dysfunction that are currently in press. Based on our findings, we will be able to define algorhytm for management of patients with clinical suspicion of heart failure in the primary care setting.
This will be a two-stage project: in first stage, we will use National Hospitalization Database and Central Population Registry to evaluate hospitalizations and mortality; in second stage, a cross-sectional prevalence study in general population will be conducted.
In retrospective survey, National Hospitalization Database a period from 2004 to 2012 will be analyzed for all hospitalizations with discharge diagnosis of heart failure as coded in International Classification of Disease, version 10 (ICD-10). We will merge patient data with Central Population Registry to analyze survival. Primary end-point will be heart failure hospitalization.
In second stage, heart failure prevalence will be determined. We will invite inhabitants from Zagorje ob Savi municipiality aged 55 years or more (N=2334) for NT-proBNP screening. According to diagnostic algorithm of the European Society of Cardiology heart failure is very unlikely if NT-proBNP is (125 pg/mL; this result is expected for 70% of tested participants whilst the remaining 30% will be invited to a detailed examination. Additionally, an age and gender matched population (100-150 individuals) with negative NT-proBNP during screening will also be invited for detailed examination. Heart failure diagnosis will be adjudicated by a 3-member international panel, unrelated to study procedures. Primary endpoint of this stage will be heart failure diagnosis.
Significance for science
This study will provide national epidemiological data about heart failure burden. This information is also of international importance as these data for countries in transition and countries in this region is non-existing. In second part of our project, we will apply new criteria for diagnosis of diastolic dysfunction; this is going to be first validation in epidemiological study. Based on our findings, hospitalization and mortality trends in patients with heart failure will be evaluated; these also reflect the efficacy and adequacy of patient management. In prevalence study, we will also validate the natriuretic peptides cut-off as currently used in clinical practice to rule-out the cardiac aetiology of dyspnea.
Additionally, heart failure patient phenotypes, e.g. type of heart dysfunction (heart failure with reduced and with preserved ejection fraction), comorbidity profile (ischemic heart disease, atrial fibrillation, diabetes mellitus, chronic kidney disease), patient physical characteristic and performance (body composition) will be assessed. This comprehensive dataset will set the stage for future research, particularly in fields of heart failure screening and management of relevant comorbidity.
Preliminary findings have been presented or are accepted for presentation at the
Heart Failure Association of the European Society of Cardiology congress (Sevilla, 2015; kargest heart failure congress in the world), Health Promoting Hospitals congress (Oslo, 2015), and European Society of Cardiology congress (London, 2015; largest cardiology congress in the world). Paper base on prelimnary data is under review in the European Journal of Heart Failure, the highest ranked specialized heart failure journal in the world (IF 2014 = 6.526).
Significance for the country
Findings will enable economical analysis and will be basis for planning and implementation of interventions to improve heart failure management at a national level and through ministry, insurance and healthcare institution coordinated interventions. Primarily, a network of multidisciplinary heart failure outpatient settings should be pursued. In international scientific guidelines, these are labeled with highest possible class of recommendation and level of evidence and should be part of good clinical practice at national level. Findings about natriuretic peptides and echocardiography should help us to bridge differences between primary and secondary level of health care. General practitioners should, according to international guidelines, have access to basic diagnostics in suspected heart failure; here, natriuretic peptides are first step with good cost-benefit ratio and should direct patient management. In current health care system organization, both issues are neglected in terms of staff, material costs, and reimbursement. Our study will provide wealth of (national) data and should be the basis for negotiation with all parties (ministries, health insurance companies, health care providers) to improve management of Slovenian population.
Study results are estimated to have international impact, as we will obtain insight in regional epidemiology; finally, the findings will likely be included in next Heart Failure Association documents (position statements, consensus documents, guidelines).
Most important scientific results
Interim report,
final report
Most important socioeconomically and culturally relevant results
Final report
