Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons
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Heart failure (HF) continues to be a leading cause of morbidity and mortality in industrialized countries. Data on the epidemiology of HF are largely lacking for Germany. The aims of this study were to estimate the incidence and prevalence of HF in Germany, to estimate 1-year all-cause mortality in patients who received their first diagnosis of HF in hospital and to assess related risk factors.
The study was based on data for the years 2004–2006 from three German statutory health insurance providers, comprising data of more than six million people. The study sample was not restricted to a specific age group. The incidence rate of HF in 2006 was assessed in patients who did not have a diagnosis of HF or had not received medications for HF in the previous 2 years. One-year all-cause mortality in patients who received their first diagnosis of HF in hospital was analysed using Kaplan–Meier method and Cox proportional hazard model. Case identification was based on confirmed outpatient diagnoses, main and secondary hospital discharge diagnoses as well as medications for HF.
The age- and sex-standardized incidence rate of HF was 2.7 per 1000 person years. Age- and sex-standardized prevalence of HF was 1.7 % in 2004, 1.9 % in 2005 and 1.7 % in 2006. The 1-year all-cause mortality was 23 % among patients who received their first HF diagnosis during a hospitalization in 2006.
Our study revealed an incidence and prevalence of HF in Germany which were largely comparable to those from other countries. Due to the poor prognosis of HF, high readmission rates and an aging society, HF remains highly relevant in the context of health care planning.
KeywordsHeart failure Incidence Prevalence Mortality Germany Health insurance data
The authors are grateful to all statutory health insurances that provided data for this study, namely the AOK Bremen/Bremerhaven, the Techniker Krankenkasse (TK), and the hkk. This work was supported by the Robert Koch-Institute, [Grant Number 1362/1-922].
Conflict of interest
The authors had complete autonomy for the process of establishing the protocol, carrying out the analyses and interpreting the results. This also includes the full right to publish the results without limitation. Rafael Mikolajczyk reports grants from Bayer Pharma, grants from Sanofi Pasteur, outside the submitted work. Wilhelm Haverkamp reports speaker’s bureau activities for Bayer HealthCare, Boehringer Ingelheim, Daiichi Sankyo and Berlin Chemie.
Use of the data for research purposes needs to be approved by the contributing SHIs and by their governing local or federal authorities. In accordance with the Code of Social Law (SGB X), informed consent of the insurants was not required. Since the study was based on routinely collected pseudonymized data and persons were not contacted, a vote of the ethics committee was not needed.
- 4.Gerste B, Günster C, Heller G, Hilfer S (2007) Sektorenübergreifende Leistungsanalysen. Inanspruchnahme von Gesundheitsleistungen durch Patienten mit koronarer Herzkrankheit und Herzinsuffizienz, BonnGoogle Scholar
- 6.Statistisches Bundesamt (2011) Gesundheit: Diagnosedaten der Patienten und Patientinnen in Krankenhäusern, WiesbadenGoogle Scholar
- 7.Statistisches Bundesamt (2010) Gesundheit: Krankheitskosten, 2002, 2004, 2006 and 2008, WiesbadenGoogle Scholar
- 14.Deutsches Institut für Medizinische Dokumentation un Information (2011) Internationale Statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme: 10. Revision: Version 2008. https://www.dimdi.de/static/de/klassi/icd-10-gm/kodesuche/onlinefassungen/htmlgm2008/index.htm. Accessed 26 Jan 2014
- 16.Newcombe R, Altman D (2000) Proportions and their differences. In: Altman D, Machin D, Bryant T, Gardner M (eds) Statistics with confidence. British Medical Journal Books, Bristol, pp 45–56Google Scholar
- 17.International Agency for Research on Cancer (1976) Cancer incidence in five continents. Volume IIV, LyonGoogle Scholar
- 22.Leong KT, Goh PP, Chang BC, Lingamanaicker J (2007) Heart failure cohort in Singapore with defined criteria: clinical characteristics and prognosis in a multi-ethnic hospital-based cohort in Singapore. Singap Med J 48(5):408–414Google Scholar
- 23.Cleland JG, McDonagh T, Rigby AS, Yassin A, Whittaker T, Dargie HJ, National Heart Failure Audit Team for E, Wales (2011) The national heart failure audit for England and Wales 2008–2009. Heart 97(11):876–886Google Scholar
- 25.Schink T, Garbe E (2010) Assessment of the representativity of in-patient hospital diagnoses in the German Pharmacoepidemiological Research Database. Pharmacoepidemiol Drug Saf 19:S178–S179Google Scholar
- 26.Schink T, Garbe E (2010) Representativity of dispensations of non-steroidal anti-inflammatory drugs (NSAIDs) in the German Pharmacoepidemiological Research Database. Pharmacoepidemiol Drug Saf 19:S294Google Scholar
- 27.Ohlmeier C, Schmedt N, Hillebrand K, Langner I, Mikolajczyk R, Garbe E (2013) Validation of mortality related information in the German Pharmacoepidemiological Research Database (GePaRD). Pharmacoepidemiol Drug Saf 22(S1):306Google Scholar