Prevalence and incidence of heart failure in Hungary stratified by age and sex: data from the Hungarian nationwide epidemiological study (HF-EPI-HUN) over a 15-year period (2009-2023)

Background There is a significant variability in the prevalence estimates for heart failure (HF) around the world, ranging from figures as low as 0.37% to as high as 6%. Since such data are not readily available for Hungary, we aimed to investigate the fundamental epidemiological data and their temporal trends through a nationwide HF epidemiological study. Methods The database of the Hungarian National Health Insurance Fund was queried to identify all inpatient and outpatient cases diagnosed with heart failure (HF) between January 1, 2009, and December 31, 2023. Patients with ICD codes I11, I13, I23, I42, I43, I50, or J81 in inpatient care, or with these codes as the primary or secondary diagnosis codes in outpatient care, were included in the study. A two-year screening period between January 1, 2009, and December 31, 2010, was applied. The index date of diagnosis was defined as the first date the inclusion criteria were met. Results A total of 671 368 patients were enrolled. The number of prevalent cases of HF varied from 163,723 in 2011 [crude rate: 1.64%; European Standard Population (ESP) rate: 1.84%] to 247,095 in 2019 (crude rate: 2.53 %; ESP rate: 2.55%). Prevalence was the highest in patients over 70 years of age (ranging from 8.3% in 2011, rising to 10.3% in 2016, and declining to 8.6% in 2023). Patients with 60-69 years of age had the second highest prevalence, rising gradually from 3.1% in 2011 to 5.4% in 2023. Prevalence was increasing and was almost identical in males and females between 2011 and 2016 with a crude rate value of 1.7 to 2.5%, then was rising further in males to 2.6% in males and decreasing to 2.4% in females until 2023. The incidence rate of new HF cases showed a gradual decline, decreasing from 64,368 cases (crude rate: 0.65%; ESP rate: 0.73%) in 2011 to 48,636 cases (crude rate: 0.50%; ESP rate: 0.51%) in 2019 and a subsequent rise again between 2021 and 2023, ranging from 44,344 to 47,500 incident cases (crude rate: 0.46%; ESP rate: 0.45%). Incidence was the highest in patients over 70 years of age (ranging from 3.7% in 2011, declining steeply to 2.4% in 2023). Patients of 60-69 years of age had the second highest incidence, showing a gradual decline from 1.1% in 2011 to 0.7% in 2023. Incidence was lower in males from 2011 to 2016 (from 0.62 to 0.53% in males vs. 0.67% to 0.53% in females) and almost identical afterwords. In 2020, a sudden reduction to 41,047 incident cases (crude rate: 0.42%; ESP rate: 0.42%) was observed, possibly due to restricted access to healthcare services during the pandemic. This reduction affected more the older age groups but equally males and females. Conclusions HF epidemiology data in Hungary showed an increasing prevalence and decreasing incidence rates over the investigated time period. HF affects older populations but the increase of prevalence in the age group of 60-69 years of age is the most pronounced.