HF prevalence may be higher than estimates in low- to middle-income countries
The age-standardized prevalence of HF in low- to middle-income countries may be much higher than modeling estimates suggest and signals the persistence of global CVD health disparities, according to researchers.
“Our data underscore that HF is a likely an underrecognized cardiovascular disease and health disparity, given the difference in modeling estimates as compared to our population-based data and given the difference in prevalence and age of onset among this Haitian cohort as compared to higher-income settings,” Justin R. Kingery, MD, PhD, associate professor of medicine at University of Louisville School of Medicine, and colleagues wrote in Circulation: Cardiovascular Quality and Outcomes.
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To determine HF prevalence in low- to middle-income countries, Kingery and colleagues analyzed 2,981 participants in Port-au-Prince, Haiti, aged 18 years or older (median age, 40 years; 58.2% women) from the population-based Haiti Cardiovascular Disease Cohort between March 2019 and August 2021.
Participants were selected via a multistage, cluster-area random sampling system. Upon enrollment in the study, participants completed medical exams, BP measurements, echocardiograms, study questionnaires and lab testing. The median follow-up period was 15.4 months.
Kingery and colleagues found that the age-standardized HF prevalence of the cohort was 3.2% (95% CI, 2.6-3.9). Among those with HF, the mean age was 57 years and 67.7% were women.
In a multivariate analysis, the following factors were associated with elevated risk for HF: age (adjusted OR per 10-year increase = 1.36; 95% CI, 1.12-1.66), hypertension (aOR = 2.14; 95% CI, 1.26-3.66), obesity (aOR = 3.35; 95% CI, 1.99-5.62), poverty (aOR = 2.1; 95% CI, 1.18-3.72) and renal dysfunction (aOR = 5.42; 95% CI, 2.94-9.98).
The most common HF subtype was HF with preserved ejection fraction (71%). Women were more likely to have HF than men (3.6% vs. 2.4%; P < .05). The highest increase in prevalence by age was between 30 to 39 years and 40 to 49 years (P < .003). The 1-year mortality rate was 6.6% for those with HF vs. 0.8% for those without HF (aHR = 7.7; 95% CI, 2.9-20.6; P < .0001).
“HF prevalence may be dramatically higher than previously reported, and HF may represent an impending crisis in already fragile health care systems in these under-resourced settings most subject to diagnostic, economic and environmental constraints,” Kingery and colleagues wrote. “As the prevalence of HF is expected to rise given the burgeoning CVD epidemic across low- to middle-income countries, coordinated efforts are needed to describe the burden and characteristics of HF globally and inform both policymakers and interventions for prevention and treatment.”
Kingery and colleagues also acknowledged the need for future research on the topic.
“Research is urgently needed to further characterize HF at the population level in other low- to middle-income countries, where 4 billion persons live, to guide accurate international resource allocation and develop pragmatic interventions to improve HF prevention, diagnosis and treatment to ultimately reduce global CVD health disparities.”
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