Background

Although heart failure (HF) is associated with high morbidity and mortality, implementation of guideline-recommended therapies among eligible patients is poor. Earlier identification of HF patients might improve this, e.g. during primary care visits unrelated to HF symptoms. However, reliable data on the prevalence of HF and its phenotypes (HF with reduced, mid-range or preserved ejection fraction; HFrEF, HFmrEF and HFpEF, respectively) as well as on factors which identify HF patients at the population level are scarce.

Aim

The aim of this study was to describe the prevalence of HF phenotypes in the general population and to identify independent predictors of prevalent HF.

Methods

This analysis is based on the Hamburg City Health Study, which is a population-based cohort study of inhabitants of Hamburg, Germany selected at random and aged 45-74 years. Study subjects were classified as having HFrEF, HFmrEF, HFpEF or no HF based on the current guideline definition of HF. A logistic regression model was fitted to investigate predictors of prevalent HF, adjusted for demographics, clinical variables, comorbidities and laboratory markers. 

Results

Of the 7,136 study subjects included into this analysis, 372 (5%) had HF; among individuals with HF, 44 (12%) had HFrEF, 133 (36%) had HFmrEF and 195 (52%) had HFpEF; and N=300 (71%) of the HF patients were oligosymptomatic. In the multivariable-adjusted logistic regression model, several variables were predictors of prevalent HF: male sex [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.04-1.07, p<0.01], higher body mass index (OR 1.02, 95% CI 1.01-1.03, p<0.01), prevalent diabetes (OR 1.04, 95% CI 1.01-1.06, p<0.01), prior myocardial infarction (OR 1.16, 95% CI 1.12-1.20, p<0.01), prevalent atrial fibrillation (OR 1.12, 95% CI 1.09-1.15, p<0.01) and higher NT-proBNP (OR 1.10, 95% CI 1.09-1.11, p<0.01). 

Conclusion
In this middle-aged population cohort of inhabitants of Hamburg, HF was prevalent in 5% and distribution between HFpEF and HFrEF/HFmrEF was comparable, but most subjects with HF were oligosymptomatic. 

Given the high health care burden of HF and the efficacy of guideline-recommended HF therapies even in patients with no/few symptoms, these findings support the rationale for HF screening at the population level. This could be achieved by using the identified predictors (e.g. sex, body mass index, comorbidities and NT-proBNP), which are readily available in the primary care setting.