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

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. 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. 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. 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.