ABC | Volume 114, Nº2, February 2020

Original Article Fernandes et al. Heart failure trends in Less developed Brazil Arq Bras Cardiol. 2020; 114(2):222-231 Figure 1 – Trends in absolute number of hospitalizations from heart failure from 2008 to 2017 in Paraiba (A) and regions of Brazil (B). 8,000 300,000 250,000 200,000 150,000 50,000 100,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Hospitalizations Year Year Hospitalizations Hospitalizations from Heart Failure in Paraiba (2008-2017) Hospitalizations from Heart Failure per region of Brazil (2008-2017) North Northeast Southeast South Center-West Total A B in 2008 to 10.9% in 2017, and by 30.1% in Brazil (R = 0.981; p = 0.003; Table 3), from 8.3% in 2008 to 10.8% in 2017 (Figure 3A). The increase in in-hospital mortality rate from HF by gender was also significant for both men and women in Paraiba (R = 0.828; p = 0.013 and R = 0.908; p = 0.006, respectively; Table 2). This trend was also observed for both sex in Brazil, in a similar magnitude of effect (R = 0.985; R = 0.980; p = 0.003; Table 3). The in-hospital HF mortality rate per age range was highest in individuals older than 80 years old, with a mean of 14.7% in Paraiba and 14.5% in Brazil (Figure 5) from 2008 to 2017. In this age range, the in-hospital mortality rate from HF per gender in Paraiba was 12.4% in men and 15.2% in women, and in Brazil, 13.7% in men and 14.9% in women. Length of hospital stay The average length of hospital stay for HF was 5.9 days (±0.8) in Paraiba and 6.9 days (±0.4) in Brazil, with a significant increase of 44% (R = 0.953; p = 0.004; Table 2) and 12.3% (R = 0.960; p = 0.004; Table 3), respectively, between 2008 and 2017 (Figure 6). In Table 4, we present the duration of hospital stay per year, and the associated cost, both in Paraiba and Brazil. Discussion To our knowledge, this is the first study to describe the trends of HF epidemiology in a less developed region of Brazil. Information regarding the incidence, prevalence, morbidity Table 1 – Descriptive statistics of Heart Failure epidemiology in Paraiba, from 2008 to 2017 Variables Mean Standard deviation Shapiro-Wilk significance* Deaths (population) † 739.88 32.92 0.385 Women 387.88 24.07 0.916 Men 349.63 17.71 0.099 Deaths (in-hospital) 474.50 95.52 0.324 Women 238.80 46.15 0.763 Men 234.70 52.04 0.161 Population mortality rate (per 100,000) † 19.16 1.09 0.775 In-hospital mortality rate (per 100) 9.76 1.84 0.659 Number of admissions 5117.20 1805.13 0.176 Mean duration of hospitalization (days) 5.92 0.80 0.121 *In the Shapiro-Wilk test, the null hypothesis is that the population follows a normal distribution; if p < 0.05, the data is not normally distributed; † Year interval: 2008‑2015; Source of data: SUS Information System (DATASUS) and Brazilian Institute of Geography and Statistics (2010). 224