Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Aims

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. McMurray JJ, Pfeffer MA (2005) Heart failure. Lancet 365(9474):1877–1889

    Article  PubMed  Google Scholar 

  2. Bui AL, Horwich TB, Fonarow GC (2011) Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8(1):30–41

    Article  PubMed Central  PubMed  Google Scholar 

  3. Zarrinkoub R, Wettermark B, Wandell P, Mejhert M, Szulkin R, Ljunggren G, Kahan T (2013) The epidemiology of heart failure, based on data for 2.1 million inhabitants in Sweden. Eur J Heart Fail 15(9):995–1002

    Article  PubMed  Google Scholar 

  4. Gerste B, Günster C, Heller G, Hilfer S (2007) Sektorenübergreifende Leistungsanalysen. Inanspruchnahme von Gesundheitsleistungen durch Patienten mit koronarer Herzkrankheit und Herzinsuffizienz, Bonn

    Google Scholar 

  5. Hoffmann F, Icks A (2012) Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor. Gesundheitswesen 74(5):291–297

    Article  CAS  PubMed  Google Scholar 

  6. Statistisches Bundesamt (2011) Gesundheit: Diagnosedaten der Patienten und Patientinnen in Krankenhäusern, Wiesbaden

  7. Statistisches Bundesamt (2010) Gesundheit: Krankheitskosten, 2002, 2004, 2006 and 2008, Wiesbaden

  8. Cleland JG, Gemmell I, Khand A, Boddy A (1999) Is the prognosis of heart failure improving? Eur J Heart Fail 1(3):229–241

    Article  CAS  PubMed  Google Scholar 

  9. Blackledge HM, Tomlinson J, Squire IB (2003) Prognosis for patients newly admitted to hospital with heart failure: survival trends in 12 220 index admissions in Leicestershire 1993–2001. Heart 89(6):615–620

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Jong P, Vowinckel E, Liu PP, Gong Y, Tu JV (2002) Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study. Arch Intern Med 162(15):1689–1694

    Article  PubMed  Google Scholar 

  11. MacIntyre K, Capewell S, Stewart S, Chalmers JW, Boyd J, Finlayson A, Redpath A, Pell JP, McMurray JJ (2000) Evidence of improving prognosis in heart failure: trends in case fatality in 66 547 patients hospitalized between 1986 and 1995. Circulation 102(10):1126–1131

    Article  CAS  PubMed  Google Scholar 

  12. Garbe E, Suling M, Kloss S, Lindemann C, Schmid U (2011) Linkage of mother-baby pairs in the German pharmacoepidemiological research database. Pharmacoepidemiol Drug Saf 20(3):258–264

    Article  PubMed  Google Scholar 

  13. Pigeot I, Ahrens W (2008) Establishment of a pharmacoepidemiological database in Germany: methodological potential, scientific value and practical limitations. Pharmacoepidemiol Drug Saf 17(3):215–223

    Article  PubMed  Google 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

  15. Daly LE (1998) Confidence limits made easy: interval estimation using a substitution method. Am J Epidemiol 147(8):783–790

    Article  CAS  PubMed  Google Scholar 

  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 45–56

    Google Scholar 

  17. International Agency for Research on Cancer (1976) Cancer incidence in five continents. Volume IIV, Lyon

  18. Fay MP, Feuer EJ (1997) Confidence intervals for directly standardized rates: a method based on the gamma distribution. Stat Med 16(7):791–801

    Article  CAS  PubMed  Google Scholar 

  19. Bleumink GS, Knetsch AM, Sturkenboom MC, Straus SM, Hofman A, Deckers JW, Witteman JC, Stricker BH (2004) Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J 25(18):1614–1619

    Article  PubMed  Google Scholar 

  20. Cowie MR, Wood DA, Coats AJ, Thompson SG, Poole-Wilson PA, Suresh V, Sutton GC (1999) Incidence and aetiology of heart failure; a population-based study. Eur Heart J 20(6):421–428

    Article  CAS  PubMed  Google Scholar 

  21. Regitz-Zagrosek V, Oertelt-Prigione S, Seeland U, Hetzer R (2010) Sex and gender differences in myocardial hypertrophy and heart failure. Circ J 74(7):1265–1273

    Article  CAS  PubMed  Google 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):408–414

    CAS  Google 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):876–886

  24. Khand AU, Shaw M, Gemmel I, Cleland JG (2005) Do discharge codes underestimate hospitalisation due to heart failure? Validation study of hospital discharge coding for heart failure. Eur J Heart Fail 7(5):792–797

    Article  PubMed  Google 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–S179

    Google 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:S294

    Google 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):306

    Google Scholar 

Download references

Acknowledgments

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.

Ethics

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.

Author information

Authors and Affiliations

  1. Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Achterstr. 30, 28359, Bremen, Germany

    Christoph Ohlmeier, Johann Frick & Edeltraut Garbe

  2. Helmholtz Centre for Infection Research, Inhoffestr. 7, 38124, Braunschweig, Germany

    Rafael Mikolajczyk

  3. Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Rafael Mikolajczyk

  4. Robert Koch-Institute, General-Pape-Str. 62-64, 12101, Berlin, Germany

    Franziska Prütz

  5. Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Wilhelm Haverkamp

  6. Core Scientific Area ‘Health Sciences’ at the University of Bremen, Grazer Str. 2, 28334, Bremen, Germany

    Edeltraut Garbe

Authors
  1. Christoph Ohlmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rafael Mikolajczyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johann Frick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franziska Prütz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wilhelm Haverkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edeltraut Garbe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edeltraut Garbe.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (doc 86 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ohlmeier, C., Mikolajczyk, R., Frick, J. et al. 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. Clin Res Cardiol 104, 688–696 (2015). https://doi.org/10.1007/s00392-015-0841-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-015-0841-4

Keywords

Search

Navigation