Heart Failure-Attributed Mortality in Europe, 2012–2021

AIMS: Heart failure (HF) is a leading cause of cardiovascular mortality worldwide. However, comprehensive and updated assessments of HF-attributable mortality trends across Europe are limited. The aim of this study was to evaluate HF-attributed mortality trends in Europe between 2012 and 2021, examining variations by age, sex, and European region. METHODS AND RESULTS: We extracted HF-attributed mortality data from the World Health Organization (WHO) mortality dataset for 2012-2021. Age-adjusted mortality rates (AAMRs) were analysed using joinpoint regression modelling, expressed as average annual percent change (AAPC) with 95% confidence intervals (CIs). A parallelism test compared trend differences across groups. To explore contributors to HF-attributable mortality, we analysed the mean alcohol consumption and the age-adjusted prevalence and trends of smoking habit, arterial hypertension (HTN), obesity and type 2 diabetes mellitus (DM) using the WHO non-communicable diseases dataset (2012-2021). From 2012 to 2021, 4 872 634 individuals (2 084 521 men and 2 788 113 women) died due to HF, equating to 11 522 deaths per 100 000 population. Overall, the AAMR increased (AAPC: +0.4% 95% CI 0.3-0.5, p < 0.001), with a significantly greater increase in men compared to women (p for parallelism = 0.02). HF-attributable mortality trend had a higher increase among patients aged less than 70 years compared to those aged 70 years or older (p for parallelism = 0.001). Regionally, AAMRs increased in Western (AAPC: +1.2% 95% CI 1.0-1.4, p < 0.001), Eastern (AAPC: +0.9% 95% CI 0.7-1.0, p < 0.001) and Northern Europe (AAPC: +0.5 95% CI 0.3-0.6, p < 0.001) while plateaued in Southern Europe (AAPC: +3.2% 95% CI -3.2 to 10.1, p = 0.28). A similar increase was observed in the trend for AAMR in HF-attributable mortality among subjects died due to HF with reduced or preserved ejection fraction (p for parallelism = 0.18). During the same period, the age-adjusted prevalence of overweight, obesity and DM rose, while HTN, smoking habit and alcohol consumption decreased. CONCLUSIONS: Heart failure-attributed mortality in Europe increased between 2012 and 2021. Substantial disparities persist across European regions and countries.