Prevalence of Chronic Heart Failure, Associated Factors, and Therapeutic Management in Primary Care Patients in Spain, IBERICAN Study

Jose L Llisterri-Caro; Sergio Cinza-Sanjurjo; Vicente Martín-Sánchez; Gustavo C Rodríguez-Roca; Rafael M Micó-Pérez; Antonio Segura-Fragoso; Sonsoles Velilla-Zancada; Jose Polo-García; Alfonso Barquilla-García; Luis Rodríguez Padial; Miguel A Prieto-Díaz; On Behalf Of The Investigators Of The Iberican Study And Of The Spanish Society Of Primary Care Physicians Semergen 's Foundation

doi:10.3390/jcm10184036

Prevalence of Chronic Heart Failure, Associated Factors, and Therapeutic Management in Primary Care Patients in Spain, IBERICAN Study

J Clin Med. 2021 Sep 7;10(18):4036. doi: 10.3390/jcm10184036.

Authors

Affiliations

¹ Spanish Society of Primary Care Physicians (SEMERGEN)'s Foundation, 28009 Madrid, Spain.
² Porto do Son Health Center, Health Area of Santiago de Compostela, 15970 Santiago de Compostela, Spain.
³ Institute of Biomedicine (IBIOMED), University of León, 24004 León, Spain.
⁴ Epidemiology and Public Health Networking Biomedical Research Center (CIBERESP), 24004 León, Spain.
⁵ La Puebla de Montalbán Health Table Center, 45516 Toledo, Spain.
⁶ Fontanars dels Alforins Health Center, Xàtiva-Ontinyent Department of Health, 46635 Valencia, Spain.
⁷ Medicine Department, University of Castilla-La Mancha, 13003 Toledo, Spain.
⁸ Joaquin Elizalde Health Center, 26004 Logroño, Spain.
⁹ Casar de Cáceres Health Center, 10190 Cáceres, Spain.
¹⁰ Trujillo Health Center, 10200 Cáceres, Spain.
¹¹ Servicio de Cardiología, Complejo Hospitalario de Toledo, 45071 Toledo, Spain.
¹² Vallobín-La Florida Health Center, 33012 Oviedo, Spain.

Abstract

Background: The prevalence of chronic heart failure (CHF) in patients assisted in primary care is not well known. We investigated the prevalence of CHF, its associated factors, and its therapeutic management.

Methods and findings: This was a cross-sectional, multicenter study conducted in primary care (PC) in baseline patients of the IBERICAN study (Identification of the Spanish Population at Cardiovascular and Renal Risk). CHF was defined as the presence of this condition in the medical history, classifying patients according to the type of ventricular dysfunction in CHF with preserved ejection fraction (pEF), or CHF with reduced ejection fraction (rEF). Clinical characteristics, relationship between CHF and main cardiovascular risk factors (CVRF), and drug treatments used according to ejection fraction (EF) were analyzed.

Results: A total of 8066 patients were included (54.5% women), average age (SD) was 57.9 (14.8) years, of which 3.1% (95% CI: 2.3-3.7) presented CHF, without differences between men and women. CHF with pEF (61.8%; 95% CI: 55.5-67.6) was more frequent in women, and CHF with rEF (38.1%; 95% CI: 33.2-45.5) (p = 0.028) was similar in both genders (65.9%; 95% CI: 57.1-73.4 vs. 57.3%; 95% CI: 47.7-65.8) (p = 0.188). A progressive increase of the prevalence with age (15.2% in ≥80 years) and with the aggregation of CVRF was observed. The most prescribed treatments were beta-blockers (54.7%) followed by angiotensin converting enzyme inhibitors (42.8%) and angiotensin II receptor antagonists (41.3%), without differences between pEF and rEF. The variables that are most associated with the probability of suffering CHF were a personal history of left ventricular hypertrophy (OR: 5.968; p < 0.001), of atrial fibrillation (OR: 3.494; p < 0.001), and of peripheral vascular disease (OR: 2.029; p < 0.001).

Conclusions: Three in every 100 patients included in the IBERICAN study presented CHF, of which two thirds had pEF. The condition increased exponentially with age and aggregation of CVRF. We did not find any differences in drug treatment according to the type of ventricular dysfunction. The treatment of HF with rEF has much room for improvement.

Keywords: chronic heart failure; drug treatment; prevalence; primary care.