Prevalence of heart failure in Turkish adult population: Results from Heart failure Prevalence and Predictors in TurkeY (HAPPY) study

Transcription

1 Prevalence of heart failure in Turkish adult population: Results from Heart failure Prevalence and Predictors in TurkeY (HAPPY) study M. Degertekin, Ç. Erol O. Ergene, Ö. Kozan, B. Mutlu, E. Ilkay, E. Eroglu, L. Tokgozoglu On behalf of the Turkish Society of Cardiology ()

2 HAPPY: Heart FAilure Prevalence and Predictors in TurkeY Primary objective To determine the prevalence of HF in adults ( 35 years of age) throughout Turkey Secondary objectives To determine reasons and distribution of risk factors concomitant with HF To determine the diagnostic value of N-terminal pro-b type natriuretic peptide (ntpro-bnp) in HF To monitor cohort of patients with HF and to examine parameters in the course of advanced stages of HF with time. To determine incidence of HF by following healthy cohort.

3 Heart Failure (HF) Prevalence According to Age and Gender Age (year) Males % (Prevalence) Females % (Prevalence) Population Distribution in Turkey and USA (Individuals 35 years of age) USA-2000 Turkey-2000 Age (year) Male Female Male Female % 55.8% 67.7% 64.3% % 16.8% 16.7% 17.4% > % 27.4% 15.6% 18.3% > Source: Census 2000 analyzed by the Social Science Data Analysis Network (SSDAN). Data were obtained from CDC/NCHS (Centers for Disease Control/National Center for Health Statistics) and NHLBI (National Heart, Lung and Blood Institute).

4 Number of individuals needed to be evaluated according to the presence of Heart Failure, estimated prevalence rates corresponding to number of individuals and approximate range between 95% CI Age (year) Gender Mean Prevalence (%) App. Range (%) Number of Volunteers M-F 1 +/ M-F 5 +/ >65 M-F 10 +/ Total _ 4650 The number of individuals was established approximately 6013 with the hypothesis of not performing laboratory tests (due to reject tests etc.) for 25% of individuals who filled the questionnaire in the field survey.

5 Sample size and distribution of subjects included in the study according to the cities N Of 81 city from 7 geographical regions of Turkey, from each region, the city with the highest population and the city with the minimum population randomly determined proportional to the population size Cross sectional Geographical random sample Miles

6 HAPPY: Parameters examined in the study Medical history Height Body weight Waist and hip circumference Blood pressure Laboratory : Nt-proBNP, Lipid Profile, Serum creatinine/serum uric acid, Whole blood count, Albuminurea etc. ECG Echocardiography Procedures It was planned for subjects with NT-proBNP 120 pg/ml and/or abnormal ECG.

7 Evaluation of the subjects- I Clinic-History History of heart Disease ECHO Normal 12 lead ECG Normal Abnormal ECG ECHO NT-pro-BNP < 120 pg/ml NT-Pro-BNP 120 pg/ml ECHO Normal No Heart Failure EF 40- <50 % Systolic Heart Failure Sytolic Function LV wall motion analysis Ejection Fraction

8 Evaluation of the subjects- II LV EF 50% E/A < 1 - age < 50 E/A < 0.8-age > 50 E/A = 1-1,5 - age < 50 E/A= 0,8-1,5 - age > 50 E/A > 1,5 EDT 220- age < 50 EDT 280- age > 50 Grade 1 Diastolic Dysfunction E/é > 10 or LVAI > 30 or LVMI M>135- K>110 gr/m2 or NTProBNP > 400 pg/ml Grade 2 Diastolic Dysfunction Grade 3 Diastolic Dysfunction

9 Results Study Population-Gender- Age Gender N Mean Age SD Min Max Female ,1 11, Male ,2 12, Total ,0 11, y 58 y 72 y

10 % HAPPY: ECG Rhythm in Age Groups Sinus Rhythm Atrial Fibrillation Atrial Flutter (year) (year) >65 (year) Total 99,2% 97,9% 96,2% 98,4% 0,4% 1,4% 3,3% 1,2% 0,1 % 0,3% 0,2% 0,2% Other 0,3% 0,4% 0,2% 0,3% Female Male Branch Blocks according to Age Groups Age groups Normal LBBB RBBB Other Blocks (year) 93,6% 0,5% 4,4% 1,5% (year) 91,9% 1,1% 4,6% 2,4% >65 (year) 87,4% 1,3% 5,7% 5,6%

11 Results HAPPY: Nt pro-bnp Groups Nt pro-bnp (pg/ml)

12 HAPPY: Nt pro-bnp according to gender and Age Nt Pro BNP (pg/ml) Female Male p ,5% 83,3% <0, ,3% 11,3% ,6% 1,7% ,3% 1,4% >1000 1,3% 2,2% Nt Pro BNP (pg/ml) (year) (year) >65 (year) p ,4% 75,5 % 49,8 % <0, ,8% 19,2% 34,4% ,4% 1,8% 5,5% ,2% 1,8% 4,4% >1000 0,3% 1,8% 5,9%

13 Results HAPPY: ATP III Metabolic Syndrome & Gender 53 % Female 47 % Male Present 47% Absent 53%

14 HAPPY: Echocardiography and heart failure Echocardiography group (n=1827) based on ECG and Nt- pro BNP findings

15 Echocardiography: Criteria for HF Systolic Dysfunction (SD) Heart Failure (SHF) EF < 50 % EF 40 % Diastolic Dysfunction (DD) EF 50%, Heart valve disease, cardiomyopaties, and others.( excluded from DD group) Mitral E/A <1, 1-1.5, >1.5 (>50 year 0.8 ratio were used) If E/ A <1 (Stage 1) EDT <50 year=220msn, 50 year =280 msn If E/ A (Stage 2) LAVi 30 ml/m2 (left atrium volume index) E/e 10 (Doppler Tissue and conventional ) LVMI : (LVMI Female=110, Male =135 gram/m2 Nt pro-bnp >400 pg/ml If E/ A >1.5, (Stage 3)

16 HAPPY: Echocardiography (ECHO) Groups Echo performed vs Echo not performed ECHO performed (n=587) ECHO not performed (n=1240) Nt pro-bnp (Median) 98,0 130,5 0,001 Gender ( n%) Female , ,6 NS Male , ,4 Age Groups (n%) (year) , ,3 0, (year) , ,6 >65 (year) , ,3 Diabetes (n%) Present 67 12, ,8 NS Creatine Groups (n%) < NS > Stages of Blood Pressure (n%) Optimal ,6 NS Normal , ,9 High Normal 81 14, ,8 Stage 1 HT , ,7 Stage 2 HT 92 16, ,3 Stage 3 HT 55 9, ,7 Rhythm AF 9 1,7 39 3,3 NS p

17 HAPPY: Echocardiography Groups Echo performed vs Echo not Performed Nt-Pro BNP (pg/ml) Mean SD Median p 120 ECHO, performed 46,8 31,6 42,0 0,007 ECHO not performed 42,2 33,2 37, ECHO performed 194,5 73,6 166,0 0,014 ECHO not performed 203,9 72,1 177, ECHO performed 505,3 58,0 515,5 0,066 ECHO not performed 478,5 58,6 475, ECHO performed 762,5 111, ,979 ECHO not performed 761,5 106,3 733,1 >1000 ECHO performed 1871,6 942,9 1615,5 0,102 ECHO not performed 3514,6 3724,9 1961,5

18 HAPPY: Echocardiography (ECHO) Groups Echo performed vs Echo not Performed Age Groups in Nt pro-bnp (pg/ml) Groups Nt-Pro BNP (pg/ml) (year) (year) >65 (year) p 120 ECHO performed 71,7 19,9 8,4 <0,001 ECHO not performed 53,1 26,1 20, ECHO performed 38,5 29,4 32,1 <0,001 ECHO not performed 25,7 27,1 47, ECHO performed 13,6 27,3 59,1 0,932 ECHO not performed 14,3 23,2 62, ECHO performed 0,0 30,8 69,2 - ECHO not performed 10,2 28,6 61,2 >1000 ECHO performed 16,7 16,7 66,7 - ECHO not performed 9,1 23,1 66,7

19 HAPPY: ECHO Results and Nt pro-bnp Echo Findings Nt Pro-BNP (pg/ml) Median Nt Pro-BNP (pg/ml) Mean Normal 50,0 79,4 97,1 Stage 1 DD 126,0 171,1 254,2 Stage 2 DD 168,0 251,8 312,2 Stage 3 DD 187,5 264,8 218,4 Systolic Dysfunction (SD-HF) 327,0 589,8 842,6 Valve disease 130,0 273,7 342,3 Congenital Heart Disease 73,0 78,1 53,0 Hypertrophic cardiomyopathy 217,0 240,9 193,4 SD

20 HAPPY Echo: Systolic Dysfunction (SD)& Diastolic Dysfunction (DD) Prevalence Symptomatic Asymptomatic SD EF % 0.4% 1.2% SD EF<50 2.5% 0.8% 1.7% DD 12.7% 3.7% 9.0% Stage 1 DD 5.6% 1.7% 3.9% Stage 2 DD 6.8% 1.9% 4.9% Stage 3 DD 0.3% 0.1% 0.3%

21 HAPPY: NT Pro- BNP>2000 & NYHA Class >2 (Symptomatic) of subjects in whom ECHO was not performed Asymptomatic Symptomatic

22 Comparison of groups Echo Dysfunction +BNP>2000 (N=261) Normal (N=3184) Age, y 60,6±11,3 49,0±10,4 <0,001 Female, % 143 (54,8) 1787 (56,1) NS DM,% 44 (17,5) 267 (9,1) <0,001 CAD, % 25 (9,9) 63 (2,2) <0,001 HT, % 191 (73,7) 1279 (42,1) <0,001 Obesity, Waist,cm 99,1±14,0 96,2±14,4 <0,001 BNP >120 pg/ml % 196 (75,1) 114 (3,6) <0,001 Albuminurea,% 74 (29,8) 335 (11,5) <0,001 AF, % 13 (5,6) 6 (0,2) <0,001 p

23 HAPPY: Etiology of Heart Failure 43% 10% 29% 5% 11% 2% BNP> 2000 pg/ml (symptomatic) BNP> 2000 pg/ml (symptomatic) 0,4 % Systolic Heart Failure EF EF < 50% 2,5 % Heart Valve Disease 0,9 % Congenital Heart Disease 0,4 % Hypertrophic Cardiomyopathy 0,2 % Hypertrophic Cardiomyopathy Diastolic Heart Failure (Symptomatic DD) 3,7 % Diastolic Heart Failure (Symptomatic DD)

24 Systolic & Diastolic Dysfunction among Turkish Population Over 35 Years of Age According to Gender Entire Group Symptomatic Asymptomatic Female Male Female Male Female Male EF EF< DD Stage 1 DD Stage 2 DD Entire Group Symptomatic Asymptomatic Stage 3 DD Female Male Female Male Female Male EF % 1.08% 0.06% 0.28% 0.17% 0.80% EF< % 1.40% 0.22% 0.47% 0.44% 0.94% DD 7.19% 5.91% 2.24% 1.84% 5.00% 4.12% Stage 1 DD 2.78% 3.23% 1.06% 1.24% 1.76% 2.04% Stage 2 DD 4.31% 2.52% 1.57% 0.92% 2.59% 1.52% Stage 3 DD 0.09% 0.19% 0.03% 0.06% 0.05% 0.10% * Adjusted for age groups, gender, geographic region and settlement.

25 Conclusion Diastolic dysfunction and HF are highly prevalent in Turkish adult population indicating the presence of a significant part of population who are at high risk for HF in Turkey. Higher prevalence of DD in women put this group under higher risk for HF in the future. Despite a younger population, prevalence estimates of HF in Turkey is as high as western European Countries.

26 Thank you for your attention

27 HAPPY : Prevalence of AF and its association with NT-proBNP levels: NSR AF p Age (year) 51.9+/ /-13.4 <0.001 Gender M/F 99.0/ / % BMI (>30 (%) Diabetes (%) CRF (GFR<60 ml/min/1.73m 2 ) (%) Metabolic Syndrome (%) Albuminurea (%) CAD (%) <0.001 NT-Pro BNP pg/ml(median) <0.001 Age per 10 year Metabolic Syndrome Multivariate Analysis OR p 1.7 p< P=0.04 CRF 3.3 p<0.001 CAD 3.0 p<0.01

28 HAPPY: NT-Pro BNP sub-group analysis Group A NT Pro BNP 120 pg/ml n: 3721 Group B NT Pro BNP pg/ml n: 711 Group C NT Pro BNP >400 pg/ml n: 218 p Age (years) <0.001 HT, % <0.001 DM, % <0.001 Known CAD,% <0.001 CRF (GFR<60ml) <0.001 Albuminurea,% <0.001 Anemia, % <0.001

29 HAPPY: NT-Pro BNP sub-group analysis The independent variables of high HF probability OR HT 1.52 P=0.032 Rural Area 1.58 p<0.001 Age per 10 year p 2.03 p<0.001 Anemia 3.23 p<0.001 CRF 2.77 p<0.001 CAD 7.26 p<0.001