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Scompenso cardiaco e terzo millennio: quali le dimensioni reali del problema?

Prof. Loreto Lancia

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STUDIO AQUORE

EPIDEMIOLOGY OF HEART FAILURE IN THE PROVINCE OF L'AQUILA

(Approved by the ethics committee of the Abruzzo Region on 19 October 2023)

SUMMARY

  • The burden of Heart Failure
  • How much does Heart Failure cost?
  • What do we know?
  • Main research questions
  • Methods
  • Preliminary results
  • Discussion
  • Conclusions

The AQUORE study, approved by the ethics committee of the Abruzzo Region on October 19, 2023, has the overall objective of conducting a descriptive and analytical epidemiological study on the impact of heart failure in the population residing in the province of L'Aquila (300,000 inhabitants).

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The burden of Heart Failure

The burden of heart failure is increasing, and is now similar to the four most common causes of cancer combined (breast, prostate, lung and bowel).

Lancet, 391(10120), 572-580.

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Ministero della Salute

Direzione Generale della Programmazione sanitaria ‐ Ufficio 6

Fonte: Elaborazione Banca Dati SDO Anno 2020

How much does Heart Failure cost?

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What do we know?

Cardiovasc Res. 2023;118(17):3272-87

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Methods: study design

The AQUORE study is a retrospective cohort study

2015 (???)

2016 (???)

2017 (???)

…..

  • Incident cases
  • Prevalent cases
  • Mortality
  • Survival
  • Rehospitalizations

2010

> 5 Ys HF Free

Up to 10 Ys Follow-up

Main outcomes

It is based on the analysis of hospital discharge records of all index hospitalizations for heart failure in the Province of L’Aquila, Italy, from 2010 to 2024

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HF Hospitalisations of resident citizens from 2010 to 2024

(18,440)

Duplicated HF Hospitalisations from 2010 to 2024

(6,881)

Principal HF Hospitalisations from 2010 to 2024

(11,559)(a)

Principal(a) HF Hospitalisations from 2010 to 2014

(4,957)

Index HF Hospitalisations from 2015 to 2024

(6,602)(b)

Index HF Hospitalisations in 2024

(493)

Index HF Hospitalisations from 2015 to 2023

(6,109)(c)

(-)

(-)

(-)

(a) Index HF hospitalization (first recorded hospitalization for HF)

(b) Incident cases (no prior HF hospitalizations in the previous 5 years)

(c) Follow-up available through December 31, 2023 (1–9 years)

Methods: Flow chart of patients’ inclusion and exclusion in the study

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What about:

      • The incidence and prevalence?
      • The mortality and survival?
      • The repeated admissions?

Preliminary results

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Preliminary results

Index HF Hospitalisations from 2015 to 2024

​

6.602

SEX

 

 

    • M

3.187 (48,3%)

    • F

3.415 (51,7%)

MARITAL STATUS

 

 

    • Single

595 (9,0%)

    • Married

2.742 (41,5%)

    • Separated/Divorced

125 (1,9%)

    • Widow

1.100 (16,7%)

    • ND

2.040 (30,9%)

AGE

 

 

    • Mean (SD)

79,6

    • Median (IQR)

82 (13)

AGE WIDE GROUP

 

 

    • <50

107 (1,6%)

    • 50-74

1.600 (24,2%)

    • 75-84

2.385 (36,1%)

    • 85+

2.510 (38,0%)

DRG

 

 

    • 124

367 (5,6%)

    • 127

5.484 (83,1%)

    • 551

260 (3,9%)

    • Others

491 (7,4%)

LOS

 

 

    • Mean (SD)

10,8

    • Median (IQR)

7 (8)

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Preliminary results: incidence

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Preliminary results: incidence

Age groups

Total crude incidence rate*

Male crude incidence rate*

Female crude incidence rate*

Total std. incidence rate*

Male std. incidence rate*

Female std. incidence rate*

<50

0,07

0,09

0,05

0,04

0,05

0,03

50-54

0,43

0,64

0,22

0,03

0,04

0,02

55-59

0,78

1,11

0,45

0,05

0,07

0,03

60-64

1,19

1,66

0,74

0,07

0,10

0,04

65-69

2,15

2,77

1,55

0,12

0,15

0,09

70-74

3,97

5,07

2,95

0,20

0,25

0,15

75-79

7,21

8,14

6,42

0,29

0,33

0,26

80-84

12,92

14,01

12,14

0,32

0,35

0,30

85-89

19,23

21,34

18,03

0,29

0,32

0,27

90+

21,96

25,80

20,44

0,22

0,26

0,20

total

2,24

2,19

2,29

1,63

1,93

1,39

* per 1,000 Residents

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Preliminary results: incidence

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Preliminary results: mortality

Years

HF-Specific Mortality Rate (per 1,000 prevalent cases)

General Population Crude Mortality Rate (per 1,000)

2015

193,23

11,97

2016

192,10

11,81

2017

176,06

12,08

2018

155,50

12,40

2019

160,62

12,64

2020

153,21

13,10

2021

147,29

13,13

2022

141,55

13,65

2023

131,54

11,98

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Preliminary results: mortality

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Cumulative rates of composite outcome (mortality and rehospitalizations) over time, stratified by age group

Preliminary results: mortality and rehospitalizations

Follow-up

Age group

Total Readmissions (%)

Total Deaths (%)

Total Composite (%)

30 Days

<50

2,1

0

2,1

50-74

4

2

5,8

75-84

5

4,6

9,2

85+

5,5

10,5

14,7

Total

4,9

6

10,2

90 Days

<50

3,1

0

3,1

50-74

7,4

5

11,6

75-84

8,8

9,2

16,6

85+

9,4

20

26,2

Total

8,6

11,9

18,6

1 Year

<50

11,3

2,1

11,3

50-74

13,2

12,6

23,2

75-84

17,5

19,6

32,3

85+

16,9

36,6

45,2

Total

16,1

23,7

34,3

5 Years

<50

32,1

15,1

35,8

50-74

26,6

36,5

50

75-84

34,1

58,1

69,6

85+

28,1

77,8

82,5

Total

30,2

59,8

69,4

9 Years

<50

27,3

27,3

36,4

50-74

36,6

57,9

71,3

75-84

43,1

82,4

87,5

85+

33,9

93,9

94,3

Total

38,3

79,9

85,4

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Cumulative probability of experiencing the first event (composite outcome, rehospitalization, or death) over time (in days) during 5-year

Preliminary results: mortality

----------- composite outcome ----------- death ----------- rehospitalization

Multivariable predictors of the 5-year composite endpoint

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Preliminary results: prevalence

HF Prevalent Cases (Dec 31, 2023) = 3931

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Discussion

According to national data, DRG 127 (Heart Failure & Shock) ranks as the third most frequent disease-related cause of hospitalization in Italy, with over 123,000 admissions in 2022 alone, totalling more than 1.2 million inpatient days and generating annual costs exceeding €374 million.

However, our findings suggest that this figure may underestimate the true burden of HF, as DRG 127 does not capture all HF cases identified through ICD-9-CM codes.

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This population-based study demonstrates that, despite recent improvements in outcomes, HF continues to be associated with substantial mortality and rehospitalization rates.

Temporal improvements observed over the study period underscore the importance of implementing effective post-discharge strategies and comprehensive long-term HF management protocols.

Nurses are positioned to play a pivotal role not only in delivering direct clinical care but also in facilitating patient self-management, supporting caregivers, coordinating follow-up care and addressing the broader educational and psychosocial needs of patients with HF.

Conclusions

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Scompenso cardiaco e terzo millennio: quali le dimensioni reali del problema?