Epidemiology and Prognosis of Heart Failure

Ilaria Spoletini, Mitja Lainscak


 In this article the state of the art of prevalence, incidence and prognosis of heart failure is discussed. Prevalence and incidence are two measures of disease occurrence. Briefly, prevalence is the proportion of the population affected by the disease at a certain point in time. Incidence indicates the number of new cases within a given time period in a population at risk for the disease (for example, elderly people). A related, prognostic measure is mortality, i.e. the incidence of death from the disease occurring in a period of time. In the case of chronic, steady- state disease such as heart failure, disease duration is directly affected by mortality, and prevalence may correspond to the incidence of disease multiplied by the average duration of disease . Prevalence rates of heart failure may, therefore, vary across studies depending on the variability in incidence as well as in survival between population samples. Also, given that heart failure is a complex syndrome with different phenotypes (see article 1), each with specific clinical characteristics and associated risk factors, prevalence and incidence rates may vary according to the definition of the heart failure subtype. Finally, rates may vary on the basis of the method of collecting data and the criterion for defining left ventricular systolic dysfunction that is applied in the study.


Cardiology; Heart Failure; Guidelines; Epidemiology; Prognosis

Full Text:

420 HTML


Bui, A. L., T. B. Horwich and G. C. Fonarow (2011). Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8(1): 30-41

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016 May 20. doi: 10.1002/ejhf.592.

Guha, K. and T. McDonagh (2013). Heart failure epidemiology: European perspective. Curr Cardiol Rev 9(2): 123-127.

McMurray, J. J., M. C. Petrie, D. R. Murdoch and A. P. Davie (1998). Clinical epidemiology of heart failure: public and private health burden. Eur Heart J 19 Suppl P: P9-16.

Redfield, M. M., S. J. Jacobsen, J. C. Burnett, Jr., D. W. Mahoney, K. R. Bailey and R. J. Rodeheffer (2003). Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289(2): 194-202.

Braunwald, E. (2013). Heart failure. JACC Heart Fail 1(1): 1-20.

McCullough, P. A., E. F. Philbin, J. A. Spertus, S. Kaatz, K. R. Sandberg, W. D. Weaver and S. Resource Utilization Among Congestive Heart Failure (2002). Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol 39(1): 60-69.

Hoes, A. W., A. Mosterd and D. E. Grobbee (1998). An epidemic of heart failure? Recent evidence from Europe. Eur Heart J 19 Suppl L: L2-9.

Rich, M. W. (2001). Heart failure in the 21st century: a cardiogeriatric syndrome. J Gerontol A Biol Sci Med Sci 56(2): M88-96.

Filippatos, G. and J. T. Parissis (2011). Heart failure diagnosis and prognosis in the elderly: the proof of the pudding is in the eating. Eur J Heart Fail 13(5): 467-471.

van Riet, E. E., A. W. Hoes, A. Limburg, M. A. Landman, H. van der Hoeven and F. H. Rutten (2014). Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail 16(7): 772-777.

Lopez-Sendòn, J. (2011). The heart failure epidemic. Medicographia 33: 363-369.

Levy, D., S. Kenchaiah, M. G. Larson, E. J. Benjamin, M. J. Kupka, K. K. Ho, J. M. Murabito and R. S. Vasan (2002). Long-term trends in the incidence of and survival with heart failure. N Engl J Med 347(18): 1397-1402.

Roger, V. L., S. A. Weston, M. M. Redfield, J. P. Hellermann-Homan, J. Killian, B. P. Yawn and S. J. Jacobsen (2004). Trends in heart failure incidence and survival in a community-based population. JAMA 292(3): 344-350.

Dulai, R., A. S. Sheikh, A. Qureshi, S. Katechia, Y. Peysakhova, M. Johns and S. Mazhar (2016). Prevalence, clinical characteristics and outcomes of HF with preserved versus reduced ejection fraction. Br J Cardiol 23(1).

Lee, D. S., P. Gona, R. S. Vasan, M. G. Larson, E. J. Benjamin, T. J. Wang, J. V. Tu and D. Levy (2009). Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute. Circulation 119(24): 3070-3077.

Fonarow, G. C., W. G. Stough, W. T. Abraham, N. M. Albert, M. Gheorghiade, B. H. Greenberg, C. M. O'Connor, J. L. Sun, C. W. Yancy, J. B. Young, O.-H. Investigators and Hospitals (2007). Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol 50(8): 768-777.

Yancy, C. W., M. Lopatin, L. W. Stevenson, T. De Marco, G. C. Fonarow, A. S. A. Committee and Investigators (2006). Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol 47(1): 76-84.

Vasan, R. S., E. J. Benjamin and D. Levy (1995). Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 26(7): 1565-1574.

Lenzen, M. J., W. J. Scholte op Reimer, E. Boersma, P. J. Vantrimpont, F. Follath, K. Swedberg, J. Cleland and M. Komajda (2004). Differences between patients with a preserved and a depressed left ventricular function: a report from the EuroHeart Failure Survey. Eur Heart J 25(14): 1214-1220.

Bursi, F., S. A. Weston, M. M. Redfield, S. J. Jacobsen, S. Pakhomov, V. T. Nkomo, R. A. Meverden and V. L. Roger (2006). Systolic and diastolic heart failure in the community. JAMA 296(18): 2209-2216.

Owan, T. E., D. O. Hodge, R. M. Herges, S. J. Jacobsen, V. L. Roger and M. M. Redfield (2006). Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355(3): 251-259.

Bleumink, G. S., A. M. Knetsch, M. C. Sturkenboom, S. M. Straus, A. Hofman, J. W. Deckers, J. C. Witteman and B. H. Stricker (2004). Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J 25(18): 1614-1619.

Rutten, F. H., M. J. Cramer, D. E. Grobbee, A. P. Sachs, J. H. Kirkels, J. W. Lammers and A. W. Hoes (2005). Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J 26(18): 1887-1894.

Ceia, F., C. Fonseca, T. Mota, H. Morais, F. Matias, A. de Sousa, A. Oliveira and E. Investigators (2002). Prevalence of chronic heart failure in Southwestern Europe: the EPICA study. Eur J Heart Fail 4(4): 531-539.

Hellermann, J. P., S. J. Jacobsen, G. S. Reeder, F. Lopez-Jimenez, S. A. Weston and V. L. Roger (2003). Heart failure after myocardial infarction: prevalence of preserved left ventricular systolic function in the community. Am Heart J 145(4): 742-748.

Badano, L. P., M. C. Albanese, P. De Biaggio, P. Rozbowsky, D. Miani, C. Fresco and P. M. Fioretti (2004). Prevalence, clinical characteristics, quality of life, and prognosis of patients with congestive heart failure and isolated left ventricular diastolic dysfunction. J Am Soc Echocardiogr 17(3): 253-261.

Peyster, E., J. Norman and M. Domanski (2004). Prevalence and predictors of heart failure with preserved systolic function: community hospital admissions of a racially and gender diverse elderly population. J Card Fail 10(1): 49-54.

Boonman-de Winter, L. J., F. H. Rutten, M. J. Cramer, M. J. Landman, A. H. Liem, G. E. Rutten and A. W. Hoes (2012). High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes. Diabetologia 55(8): 2154-2162.

Mureddu, G. F., N. Agabiti, V. Rizzello, F. Forastiere, R. Latini, G. Cesaroni, S. Masson, G. Cacciatore, F. Colivicchi, M. Uguccioni, C. A. Perucci, A. Boccanelli and P. S. Group (2012). Prevalence of preclinical and clinical heart failure in the elderly. A population-based study in Central Italy. Eur J Heart Fail 14(7): 718-729.

Tiller, D., M. Russ, K. H. Greiser, S. Nuding, H. Ebelt, A. Kluttig, J. A. Kors, J. Thiery, M. Bruegel, J. Haerting and K. Werdan (2013). Prevalence of symptomatic heart failure with reduced and with normal ejection fraction in an elderly general population-the CARLA study. PLoS One 8(3): e59225.

van Riet, E. E., A. W. Hoes, K. P. Wagenaar, A. Limburg, M. A. Landman and F. H. Rutten (2016). Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail 18(3): 242-252.

Lam, C. S., E. Donal, E. Kraigher-Krainer and R. S. Vasan (2011). Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail 13(1): 18-28.

Fang, J. C., G. A. Ewald, L. A. Allen, J. Butler, C. A. Westlake Canary, M. Colvin-Adams, M. G. Dickinson, P. Levy, W. G. Stough, N. K. Sweitzer, J. R. Teerlink, D. J. Whellan, N. M. Albert, R. Krishnamani, M. W. Rich, M. N. Walsh, M. R. Bonnell, P. E. Carson, M. C. Chan, D. L. Dries, A. F. Hernandez, R. E. Hershberger, S. D. Katz, S. Moore, J. E. Rodgers, J. G. Rogers, A. R. Vest, M. M. Givertz and C. Heart Failure Society of America Guidelines (2015). Advanced (stage D) heart failure: a statement from the Heart Failure Society of America Guidelines Committee. J Card Fail 21(6): 519-534.

Bjork, J. B., K. K. Alton, V. V. Georgiopoulou, J. Butler and A. P. Kalogeropoulos (2016). Defining Advanced Heart Failure: A Systematic Review of Criteria Used in Clinical Trials. J Card Fail.

Brouwers, F. P., R. A. de Boer, P. van der Harst, A. A. Voors, R. T. Gansevoort, S. J. Bakker, H. L. Hillege, D. J. van Veldhuisen and W. H. van Gilst (2013). Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a community-based cohort: 11-year follow-up of PREVEND. Eur Heart J 34(19): 1424-1431.

Ho, J. E., A. Lyass, D. S. Lee, R. S. Vasan, W. B. Kannel, M. G. Larson and D. Levy (2013). Predictors of new-onset heart failure: differences in preserved versus reduced ejection fraction. Circ Heart Fail 6(2): 279-286.

Gerber, Y., S. A. Weston, M. M. Redfield, A. M. Chamberlain, S. M. Manemann, R. Jiang, J. M. Killian and V. L. Roger (2015). A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med 175(6): 996-1004.

Vongmany, J., L. D. Hickman, J. Lewis, P. J. Newton and J. L. Phillips (2016). Anxiety in chronic heart failure and the risk of increased hospitalisations and mortality: A systematic review. Eur J Cardiovasc Nurs.

Maggioni, A. P., U. Dahlstrom, G. Filippatos, O. Chioncel, M. Crespo Leiro, J. Drozdz, F. Fruhwald, L. Gullestad, D. Logeart, G. Fabbri, R. Urso, M. Metra, J. Parissis, H. Persson, P. Ponikowski, M. Rauchhaus, A. A. Voors, O. W. Nielsen, F. Zannad, L. Tavazzi and C. Heart Failure Association of the European Society of (2013). EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 15(7): 808-817.

Somaratne, J. B., C. Berry, J. J. McMurray, K. K. Poppe, R. N. Doughty and G. A. Whalley (2009). The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis. Eur J Heart Fail 11(9): 855-862.

Pocock, S. J., C. A. Ariti, J. J. McMurray, A. Maggioni, L. Kober, I. B. Squire, K. Swedberg, J. Dobson, K. K. Poppe, G. A. Whalley, R. N. Doughty and F. Meta-Analysis Global Group in Chronic Heart (2013). Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J 34(19): 1404-1413.

Berry, C., K. Hogg, J. Norrie, K. Stevenson, M. Brett and J. McMurray (2005). Heart failure with preserved left ventricular systolic function: a hospital cohort study. Heart 91(7): 907-913.

Gotsman, I., D. Zwas, D. Planer, T. Azaz-Livshits, D. Admon, C. Lotan and A. Keren (2008). Clinical outcome of patients with heart failure and preserved left ventricular function. Am J Med 121(11): 997-1001.

Gotsman, I., D. Zwas, C. Lotan and A. Keren (2012). Heart failure and preserved left ventricular function: long term clinical outcome. PLoS One 7(7): e41022.

Jhund, P. S., K. Macintyre, C. R. Simpson, J. D. Lewsey, S. Stewart, A. Redpath, J. W. Chalmers, S. Capewell and J. J. McMurray (2009). Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5.1 million people. Circulation 119(4): 515-523.

Laribi, S., A. Aouba, M. Nikolaou, J. Lassus, A. Cohen-Solal, P. Plaisance, G. Pavillon, P. Jois, GC. Fonarow, E. Jougla, A. Mebazaa and G. network (2012). Trends in death attributed to heart failure over the past two decades in Europe. Eur J Heart Fail 14(3): 234-239.

Roger, V. L. (2013). Epidemiology of heart failure. Circ Res 113(6): 646-659.

Pardeep S. Jhund and Luigi Tavazzi. Has the ‘epidemic’ of heart failure been replaced by a tsunami of co-morbidities? Eur J Heart Failure. (2016); in press. doi:10.1002/ejhf.529

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 dx.doi.org/10.17987/icfj.v2i1.4

DOI: https://doi.org/10.17987/icfj.v10i0.420

Comments on this article

View all comments

Copyright (c) 2017 Mitja Lainscak, Ilaria Spoletini

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.