Multinational Study Details Contemporary Prevalence, Treatment Strategies of Heart Failure

Results of the CaReMe HF Study, which pooled registry data from 11 countries spanning 2018-2021, suggest the prevalence of heart failure could be as high as 2% of the general population and also offers insight into trends in uptake of GDMT among these patients.

A new study using data from patient registries from nearly a dozen countries is providing an updated overview of contemporary trends in prevalence, patient characteristics, and management strategies for heart failure in a multinational cohort of more than 32 million adults.

Named the CardioRenal and Metabolic disease (CaReMe) HF Study, results of the study demonstrate the prevalence of heart failure was 2.01%, with results also shedding light on the lack of uptake for newer agents, including SGLT2 inhibitors and ARNI, and the rates of comorbidities among this patient population.1

“Half of the heart failure patients had ischemic heart disease, half had signs of kidney failure and a third had diabetes,” said Anna Norhammar, MD, adjunct professor in the Cardiology Unit of the Department of Medicine at Karolinska Institutet.2 “One likely reason for the escalation in comorbidity in such patients is that we live longer nowadays with several concurrent conditions. This complicates heart failure care even more, as there are many contributory factors to take account of.”

Despite carrying a dire prognosis, most heart failure specialists argue the disease is not treated with the urgency it deserves and the impact of the chronic illness on society could be attenuated if addressed properly in screening and with guideline-directed medical therapy. Funded by AstraZeneca and citing a need for a more comprehensive understanding of the contemporary patient with heart failure, Norhammar and fellow investigators launched the CaReMe HF study. Using health registries, investigators obtained data from patient record in practices fromBelgium, Canada, Germany, Israel, Italy, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom.1

For the purpose of analysis, investigators created 3 cohorts in each country to describe patient characteristics, 1-year event rates, and hospital healthcare costs over a period of up to 5 years, respectively. Investigators also pointed out 2 distinct definitions were used to assess heart failure prevalence, with these classified as a broad definition and a strict definition. The broad definition included all patients with a registered heart failure diagnosis and the strict definition included only patients hospitalized with heart failure as the primary diagnosis.

Among a background population of more than 32 million adults, results indicated the pooled prevalence of heart failure was 2.01% (95% confidence interval [CI], 1.65-2.36) using the broad definition and 1.05% (95% CI, 0.85-1.25) using the strict definition. When examining differences among prevalence according to country, investigators pointed out the highest prevalence when using the broad definition was seen in Portugal at 2.9% while the lowest was seen in the United Kingdom at 1.4%. Investigators also pointed out the prevalence in Norway and Sweden, which both have universal health coverage, were 1.8% and 2.2%, respectively.1

A total of 629,440 patients with prevalent heart failure were identified within registries from 2018-2020. This cohort had a mean age of 75.2 years (95% CI 74.0-76.4), 48.8% (40.9-56.8%) had ischemic heart disease, 44.1% (95% CI, 39.1-49.0) had atrial fibrillation, and 34.5% (29.4-39.6) had diabetes. Of the 629,440, a total of 51,442 patients with a recorded ejection fraction (EF). Among this subgroup, 39.1% (30.3-47.8) had a reduced EF, 18.8% (13.5-24.0) had a mildly reduced EF, and 42.1% (31.5-52.8) had a preserved left ventricular EF.1

When examining treatment of these patients, results indicated 65.8% (95% CI 60.3-67.3) were being treated with RAAS inhibitors, 69.3% (95% CI, 62.5-76.1) with beta blockers, 30.2% (95% CI, 16.8-43.6) with MRAs, 3.8% (95% CI, 1.9-5.7)with ARNIs, and 2.9% (95% CI, 1.6-4.2) with SGLT2 inhibitors. Device therapy was reported among 8.2% (95% CI, 4.3-12.1) of patients with heart failure. A total of 169,518 patients had a recorded estimated glomerular filtration rate. Among this subgroup, 49% had stage 3-5 chronic kidney disease.1

“Given that we know that the incidence of heart failure increases with population age, a modern, broad view of what the heart failure population looks like, involving risks and costs, is important for all forms of care planning,” Norhammar added.2


  1. Norhammar A, Bodegard J, Vanderheyden M, et al. Prevalence, outcomes and costs of a contemporary, multinational population with heart failure. Heart. 2023. doi:10.1136/heartjnl-2022-321702
  2. Heart failure places a great strain on healthcare. Karolinska Institutet. February 2023. Accessed February 14, 2023.