Heart Failure in the Older Population - An Epidemiologic Study

Research Article

Austin Cardiol. 2016; 1(1): 1004.

Heart Failure in the Older Population - An Epidemiologic Studys

Kaufman R1,2*, Geller M3, Pereira Azevedo VM4, Oliveira L3 and Castier MB2

³Universidade Federal do Rio de Janeiro (UFRJ), Brazil

4Instituto Nacional de Cardiologia (INC), Mexico

*Corresponding author: Renato Kaufman, Instituto Estadual de Cardiologia, Universidade do Estado do Rio de Janeiro (UERJ), Brazil

Received: September 21, 2016; Accepted: December 19, 2016; Published: December 20, 2016

Abstract

Introduction: Heart Failure (HF) is commonly the final stage of all cardiopathies, and its prognosis is closely related to the number of hospitalizations.

Objective: To evaluate the evolution of the hospitalization indexes, duration, and mortality rates from 2008-2014 among HF patients over 60 years of age in the Brazilian Public Health System (SUS), compared with patients under 60.

Methods: Data were obtained from the DATASUS database, assessing hospitalizations for HF from the period of 2008 to 2014.

Results: A total of 78,117,726 hospitalizations occurred, with 22.2% among patients over 60 years of age. HF was the cause of hospitalization in 7.5% of older and 0.9% of younger patients. The absolute number of hospitalizations for HF declined from 81,359 in 2008 to 64,003 in 2014 among patients <60 years and from 187,628 in 2008 to 160,287 in 2014 among the older population. The value of hospitalization for HF increased independent of age range, as did the mean hospital stay and the mortality rate increased in both groups, but remained higher in the >60 group.

Conclusion: HF is a severe public health problem that, despite new medications that reduce hospitalizations and mortality of HF patients, the associated mortality rate continues to climb. Although the mean value of hospitalization is lower among the older population, the total cost in 5 years was more than double, especially due to the higher number of hospitalizations among these patients.

Keywords: Heart failure; Older population; Hospitalizations; Mortality rate

Introduction

Heart failure is commonly the final stage of all cardiopathies. With increased life expectancy, improvements in clinical treatment of cardiovascular disease and greater survival rates of patients submitted to chemotherapy and subsequent chemotherapy-induced cardiomyopathy, its incidence tends to increase [1-3].

With the medical advances in identification of the pathophysiology, research of new drugs to block specific systems, and the use of pacemakers and resynchronization devices for the treatment and prevention of ventricular dysfunction progression, survival and quality of life of these patients has increased progressively [1,3-9].

Heart failure is a syndrome whose prognosis is closely related to functional capacity, to the degree of systolic dysfunction, and to the number of hospitalizations. It is known that patients who are hospitalized for heart failure present a re-hospitalization rate above 50% within 6 months [1,10-14].

In Brazil, the older population (>60 years of age) has been increasing at an accelerated pace. It is predicted that the population over 60 years of age, corresponding to 10% of the total population in 2010, will reach 28.3 million (13.7%) in 2020, and 52 million (23.8%) in 2040, or nearly one quarter of the country’s total inhabitants.

The objective of this study was to evaluate the evolution of the hospitalization rates from 2008 to 2014 within the Brazilian Public Health System (Sistema Único de Saúde - SUS) among older patients (>60 years of age) with HF, length of hospitalization, and mortality rate, compared with patients <60 years of age.

Methods

Data were obtained from DATASUS, the open epidemiologic database of the Brazilian Public Health System [15]. We assessed hospitalizations due to HF (ICD-10 I50) from the period of 2008- 2014. The variables gender, number of hospitalizations, geographic region, age range, average hospitalization duration, mortality rate, and mean hospitalization cost (AIH - the mean value reimbursed by the SUS for general and disease-specific hospitalizations).

Results

From the period of 2008-2014, a total of 78,117,726 hospitalizations were recorded, of which 17,350,352 (22.2%) were for patients above 60 years of age. Of all hospitalizations for this age group, HF was the cause for hospitalization in 7.5% of cases, as compared to 0.9% among the <60 age group.

The absolute number of hospitalizations for HF declined from 81,359 in 2008 to 64,003 in 2014 (-21.3%) among patients under 60 years of age; while among patients >60, the number of hospitalizations declined from 187,628 in 2008 to 160,287 in 2014 (-14.6%).

The hospitalization cost increased among patients hospitalized for HF independently of age range, increasing from R$993.51 in 2008 to R$1,625.37 in 2014 (an increase of 63, 6%) for the <60 age group, as compared to R$889.23 in 2008 to R$1,319.11 in 2014 (48.3%) among patients >60 years of age. Calculating the hospitalization costs for HF over 7 years, the cost for patients >60 years was R$1,556,429,901.01, compared with R$770,172,424.71 for patients <60 years of age (Figure 1).

Citation:Kaufman R, Geller M, Pereira Azevedo VM, Oliveira L and Castier MB. Heart Failure in the Older Population - An Epidemiologic Study. Austin Cardiol. 2016; 1(1): 1004.