Elsevier

International Journal of Cardiology

Volume 80, Issues 2–3, September–October 2001, Pages 213-219
International Journal of Cardiology

The epidemiological features of heart failure in developing countries: a review of the literature

https://doi.org/10.1016/S0167-5273(01)00497-1Get rights and content

Abstract

Introduction

The burden of cardiovascular disease varies considerably between regions of the world. Such disease remains the number one killer in Europe and North America, accounting for almost 50% of deaths, but in developing countries it ranks third and represents about 25% of all deaths [1]. The mortality rates from cardiovascular disease have been declining in Europe, North America and Australia/New Zealand for several decades [1] but have recently accelerated in the former socialist economies [2], Latin and South America [3], India [4] and Africa [5]. In sub-Saharan Africa, the mortality rates from cardiovascular disease are likely to remain low but even here they are almost equal to the mortality rates from infectious and parasitic diseases [2], [5], [6]. Projections to the year 2020 predict that deaths from cardiovascular disease will exceed deaths from infectious and parasitic diseases for the first time in all world regions except sub-Saharan Africa [1], [2], [7], leading to a global cardiovascular disease epidemic. At least two forces are at work: control of infectious, parasitic, and nutritional diseases in developing countries; and powerful demographic changes in the structure of many countries’ populations with more people reaching the age at which cardiovascular disease manifests [2].

In the last decade heart failure has emerged as a major health problem in developed countries, imposing an escalating burden on their health care systems. European data suggest that approximately 1% of national health care budgets is spent on individuals with heart failure [8], [9], [10]. Statistics from the United States in 1991 established that heart failure was the primary discharge diagnosis in approximately 790 000 hospitalisations and constituted the leading diagnostic related group among hospitalised patients aged over 65 years of age [11]. In Scotland the number of hospital discharges with heart failure coded as the primary diagnosis rose by 60% between 1980 and 1990 [12], although the rise may have reached a plateau in more recent years [13]. Estimates of the crude incidence of heart failure in the general population in developed countries range from one to five cases per 1000 per year, with a crude prevalence ranging from three to 20 per 1000 [14]. Coronary artery disease is the single most common aetiology follow by hypertension, which frequently co-exists with coronary artery disease [15], [16].

Most of the published data on the population features of heart failure is based on work in Caucasian populations within the developed world but some data are available from the developing world. We wished to draw this information together in a review of the published literature.

Section snippets

Methods

We searched the Medline Literature database from January 1966 to August 2000 using the medical subject heading: heart failure (congestive), epidemiology, incidence, prevalence, aetiology, cardiomyopathy (congestive), rheumatic heart disease, Chagas’ disease. The search was extended using lateral references and personal communications with investigators. We also reviewed abstracts presented at the scientific meetings of the American College of Cardiology, American Heart Association, and European

Results

We found no published population-based studies of heart failure in the developing world. All of the published studies are either case series or hospital-based studies, albeit often from the only hospital within a geographical area. The lack of truly population-based studies presumably relates to the difficulty in conducting community epidemiological studies of heart failure within the resources available for research in these populations. It should be remembered that even within the developed

Discussion

The burden that heart failure has imposed on the health care systems in developed countries has been increasingly recognised in the previous 2 decades. This has encouraged proper epidemiological studies of heart failure, which have provided useful insight into how to improve the prevention, diagnosis, treatment and prognosis of heart failure in the developed world. It is likely that the ageing of the populations in developing countries coupled with epidemiological transition will lead to

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