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HFSA president-elect: Prevalence of HF underestimated in studies
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ORLANDO, Fla. — The epidemiological definitions of HF are narrow and focus only on visible symptoms, according to a presentation at the Heart Failure Society of America Annual Scientific Assembly.
Mandeep R. Mehra, MD, MB, BS, professor of medicine at Harvard Medical School and medical director of the Heart and Vascular Center at Brigham and Women's Hospital, said this narrow focus means the definition of HF is inconsistent and the prevalence of HF may be greater than assumed.
Mehra, who is also president-elect of the Heart Failure Society of America, spoke in a session on HF prevention sponsored jointly by HFSA and the American Heart Association.
“The answer to the question [of underestimating prevalence] is an unequivocal ‘yes,’” Mehra said. “A large section of the pre-symptomatic population is ignored, challenging the opportunity for earlier disease modification.”
Calling HF “a disease of aging,” Mehra said HF may be misdefined in certain studies, and the inconsistency of the definition may be a factor in why the prevalence of HF is cited as 10% in the United States but only 2% in the Netherlands.
“Most data are derived from hospital charges,” he said. “[They are] not adjudicated on standard criteria, and [they] are event-based, not person-based.”
Mehra pointed out that diagnostic classification shifts over time, and that there “are often financial up-coding incentives for such movement.”
Instead, he said, “Other biomarker and imaging-based strategies may need to be considered for more effective epidemiological adjudication.”
He said the problem was illustrated in the ICARe Dicomano study conducted in Italy and published in the Journal of the American College of Cardiology in 2004, which demonstrated significant differences in the four criteria for HF in older adults: Boston, European Society of Cardiology, Framingham and Gothenburg.
“There is a lack of focus on the spectrum of disease evolution,” Mehra said. “We know the prevalence [of HF] is too high. ... There is a lack of focus on the spectrum of disease evolution. [The key] is effective primary prevention and [working] within the epidemiological construct.” – by James Clark
Reference:
Mehra MR. The Prevention of HF (Joint Session with AHA). Presented at: Heart Failure Society of America Scientific Assembly; Sept. 17-20, 2016; Orlando, Fla.
Disclosure: Mehra reports consulting for Boston Scientific, Johnson & Johnson, Medtronic, St Jude Medical, Stealth Biopeptides, and Teva.