Who is most affected by heart failure?
Along with the Middle East and North Africa, Central Europe is among the regions most affected by heart failure worldwide – a striking fact when compared with other European countries. Hungary, for example, has over 1,000 cases of heart failure per 100,000 people, whereas Portugal has about half that number. Poland has almost five times the number of heart failure hospitalisations as Ireland. Though remarkable, these differences are not surprising; higher rates of cardiovascular disease prevalence and mortality in Central and Eastern European countries, compared to Western Europe, have been well-documented.
Best-practice care for heart failure is often limited to a few centres of excellence, as innovative models are more difficult to implement in settings with lower resources. Problems that hinder improvements in healthcare delivery for heart failure are magnified in certain countries. For example, the natriuretic peptide test used for the diagnosis of heart failure is less widely available in Eastern European and Mediterranean countries, possibly due to a lack of reimbursement.
Interestingly, there can also be significant health inequalities within the same country. For instance, higher mortality of cardiovascular disease in Spain has been observed in people with lower educational attainment. There is also a big contrast in mortality and rehospitalisation rates between the autonomous communities of Spain, with some experiencing twice as great an impact as others.
Although the underlying reasons for within-country health inequalities remain unclear, there is evidence that increased economic inequality is associated with worse outcomes for heart failure. Even after controlling for biological factors known to predict outcomes, such as the levels of natriuretic peptide, people living with heart failure in countries with high levels of income inequality have significant higher mortality.