Burden of Heart Failure in Latin America: A Systematic Review and Meta-analysis

Introduction and objectives: Heart failure is a major public health concern. The aim of this review was to estimate the burden of heart failure in Latin America. Methods: Systematic review and meta-analysis following a search in MEDLINE, EMBASE, LILACS, and CENTRAL for articles published between January 1994 and June 2014, with no language restrictions. We included experimental and observational studies with at least 50 participants aged >= 18 years. Results: In total, 143 of the 4792 references retrieved were included in the study. Most studies had been conducted in South America (92%), and mainly in Brazil (64%). The mean age of the patients was 60 +/- 9 years, and mean ejection fraction was 36% +/- 9%. The incidence of heart failure in the single population study providing this information was 199 cases per 100 000 person-years. The prevalence of heart failure was 1% (95% confidence interval [95% CI], 0.1%-2.7%); hospital readmission rates were 33%, 28%, 31%, and 35% at 3, 6, 12, and 24 to 60 months of follow-up, respectively; and the median duration of hospitalization was 7.0 days. The 1-year mortality rate was 24.5% (95% CI, 19.4%-30.0%). In-hospital mortality was 11.7% (95% CI, 10.4%-13.0%), and the rate was higher in patients with a reduced ejection fraction, ischemic heart disease, or Chagas disease. Conclusions: Few studies have evaluated the incidence and prevalence of heart failure in Latin America. High mortality and hospitalization rates were found, and the main limitation was heterogeneity between studies. The results presented provide useful epidemiologic information for decision-making related to this disease. Further studies with standardized methods and representative populations are needed in this line. (C) 2016 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.