ABC | Volume 114, Nº2, February 2020

Original Article A 10-Year Trend Analysis of Heart Failure in the Less Developed Brazil Amanda D. F. Fernandes, 1 G ilson C. Fernandes, 2 Manuel Rivera Mazza, 1 Leonardo M. Knijnik, 1 Gustavo Soares Fernandes, 3 Andre Telis de Vilela, 4 Amit Badiye, 2 Sandra V. Chaparro 2 University of Miami Miller School of Medicine – Department of Medicine, 1 Miami, Florida – USA University of Miami Miller School of Medicine – Division of Cardiology, 2 Miami, Florida – USA Centro Universitario de Joao Pessoa, 3 João Pessoa, PB – Brazil Universidade Federal da Paraiba, 4 João Pessoa, PB – Brazil Mailing Address: Amanda D. F. Fernandes • University of Miami Miller School of Medicine - Department of Medicine - 1600 N.W. 10th Avenue Miami Flórida 33136 - Estados Unidos E-mail: amandadantasff@gmail.com Manuscript received November 07, 2018, revised manuscript March 08, 2019, accepted April 10, 2019 DOI: https://doi.org/10.36660/abc.20180321 Abstract Background: Data on heart failure (HF) epidemiology in less developed areas of Brazil are scarce. Objective: Our aim was to determine the HF morbidity and mortality in Paraiba and Brazil and its 10-year trends. Methods: A retrospective search was conducted from 2008 to 2017 using the DATASUS database and included patients ≥ 15 years old with a primary diagnosis of HF. Data on in-hospital and population morbidity and mortality were collected and stratified by year, gender and age. Pearson correlation and linear-by-linear association test for trends were calculated, with a level of significance of 5%. Results: From 2008 to 2017, HF admissions decreased 62% (p = 0.004) in Paraiba and 34% (p = 0.004) in Brazil. The in‑hospital mortality rate increased in Paraiba andBrazil [65.1%(p=0.006) and 30.1%(p=0.003), respectively], but the absolute in‑hospital mortality had a significant decrease only in Paraiba [37.5% (p = 0.013)], which was maintained after age stratification, except for groups 15-19, 60-69 and > 80 years. It was observed an increase in the hospital stay [44% (p = 0.004) in Paraiba and 12.3% (p = 0.004) in Brazil]. From 2008 to 2015, mortality rate for HF in the population decreased 10.7% (p = 0.047) in Paraiba and 7.7% (p = 0.017) in Brazil. Conclusions: Although HF mortality rate has been decreasing in Paraiba and Brazil, an increase in the in-hospital mortality rate and length of stay for HF has been observed. Hospital-based clinical studies should be performed to identify the causes for these trends of increase. (Arq Bras Cardiol. 2020; 114(2):222-231) Keywords: Heart Failure/physiopathology; Heart Failure/mortality; Heart Failure/epidemiology; Comorbidity; Heart Failure/trends; Hospitalization. Introduction Heart Failure (HF) is the main cause of hospitalizations in the United States in patients older than 65 years old, 1,2 and is estimated to affect 26 million people worldwide. 3 Its prevalence has been increasing fast due to aging of the population. 1,4 A higher life expectancy has been achieved with adherence to medical therapy, ventricular assist devices (VADs) and increase in the number of heart transplants. 1 Paraiba is one of the nine states of the Northeast region of Brazil and had an estimated population in 2017 of 4,025,558 inhabitants, corresponding to the 13 th highest population among the 27 federative units of Brazil. The gross domestic product per capita of Paraiba was US$3,594.94 in 2010, corresponding to fourth poorest state in the country, and the human development index in 2014 was 0.701, the 6 th lowest in the country. 5,6 Data regarding the epidemiology of HF in less developed countries are still limited and based mainly in cohorts of hospitalized patients or clinical trials. 2 In Brazil, there is no data about the epidemiology of HF in Paraiba, and only a few reports on HF statistics in the Northeast region of Brazil. 7, 8 A better understanding of the HF epidemiology in less developed areas of Brazil, as Paraiba, through a population‑based study, could lead to a more effective and appropriate healthcare planning. The aim of this study was to describe and to perform a 10-year trend analysis of the HF morbidity and mortality in the state of Paraiba and in Brazil. Methods Study model This is a population-based time series analysis using the Hospital Information System (SIH/SUS), available at DATASUS (Department of Informatics of the Brazilian Unified Health System– SUS) database. 6 DATASUS is responsible for the administration of health and financial information declared by all states and cities, and the federal district of Brazil. This database compiles information regarding health assistance, epidemiology, morbidity and demography. 222