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 4 – (A) Absolute in-hospital deaths from heart failure in Paraiba per age range, from 2008 to 2017. (B) Absolute in-hospital deaths from heart failure in Brazil per age range, from 2008 to 2017. 1% 1% 37% 3% 5% 10% 18% 25% 28% 32% 0% 1% 2% 5% 12% 20% Absolute In-hospital HF deaths per age range in Paraiba (2008-2017) Absolute In-hospital HF deaths per age range in Brazil (2008-2017) 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years Older than 80 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years Older than 80 years A B Figure 5 – (A) Trend of the in-hospital mortality rate from heart failure in Paraiba per year and age range, from 2008 to 2017. (B) Trend of the in-hospital mortality rate from heart failure in Brazil per year and age range, from 2008 to 2017. 100% 9.02 7.18 4.82 5.21 4.14 6.91 8.46 11.54 12.14 8.80 6.93 6.19 6.11 6.89 7.25 7.46 8.54 7.09 6.39 5.80 6.26 6.42 6.16 6.41 7.25 6.99 6.51 6.24 6.62 7.14 8.30 7.12 6.99 6.19 6.77 7.61 7.27 6.82 7.36 8.84 10.82 6.76 6.46 6.91 6.66 6.25 6.93 7.40 7.83 7.98 8.20 8.13 8.37 8.85 12.77 13.14 9.36 9.88 9.74 10.22 10.23 14.17 14.35 14.32 15.08 16.05 16.60 16.58 11.52 9.18 8.86 8.17 7.69 7.32 6.76 6.41 6.88 7.38 7.56 7.81 7.77 6.48 7.58 7.43 7.31 6.85 11.15 10.06 14.52 7.56 7.36 6.77 7.90 7.57 8.53 7.58 6.06 9.68 5.08 3.23 5.41 6.2 8.47 6.51 6.04 5.26 6.7 8.91 12.68 12.82 13.45 7.98 6.29 4.77 4.94 5.6 5.97 7.15 8.96 15.02 14.42 15.19 12.03 8.24 6.11 6.54 7.11 13.33 10.53 15.22 8.33 4.63 6.27 10.23 12.12 18.5 18.62 11.45 10.31 9.82 4.81 5.61 4.35 18.18 18.18 10 7.07 6.73 7.77 7.59 7.71 7.18 10.12 16.78 14.7 9.88 7.99 6.81 5.90 10.58 10.24 10.12 8.51 6.56 6.85 7.14 5.13 8.7 9.92 8.48 8.24 8.24 7.92 3.33 4.55 4.33 80% 60% 40% 20% 0% 100% 80% 60% 40% 20% 0% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 TOTAL Year 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 TOTAL Year In-hospital mortality rate per age category and per year in Paraiba (2008-2017) In-hospital mortality rate per age category and per year in Brazil (2008-2017) In-hospital mortality rate per 100,000 individuals In-hospital mortality rate per 100,000 individuals A B 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years Older than 80 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years Older than 80 years proportion of women hospitalized for HF was 48% vs 49%, similar to studies in the U.S., with 40% to 50% of women. 3,17 A small study performed in a community in Brazil reported that 58% of hospitalized patients with HF were women. 18 Also, the I Brazilian Registry of Heart Failure (BREATHE registry) 8 describes that 60% of 1,263 admissions for HF in 51 centers of Brazil were women. In our study, mean mortality rate for HF in the population between 2008 to 2015 was 19.2/100,000 (±1.09) cases in Paraiba and 14.0/100,000 (±0.53) cases in Brazil, with a decline of 10.7% and 7.7%, respectively. A decrease in the mortality rate for HF was also reported in Brazil and Argentina: in Sao Paulo, Brazil’s largest city, there was a 29% decrease, from 19.1/100,000 (1992-1993) to 13.6/100,000 (2008-2009); 14 in Argentina, a nationwide study showed a reduction of 23% in the population HF mortality rate from 1995 to 2005. 10,19 In the U.S., Go et al. 20 compared the absolute number of HF deaths from 1995 to 2010, and found a decrease of 2.8% (287,000 vs 279,000), which potentially represents a significant decrease in the mortality rate, given the increase in the US population over 15 years. Our study reports a mean in-hospital mortality rate for HF in Paraiba of 9.2% between 2008 and 2017. A prospective study performed in 51 centers from all the Brazilian regions, only with patients hospitalized due to acute HF, reported a total of 12.6% deaths in 1,263 hospitalized patients. 8 In the LAC, ameta-analysis of 37 studies revealed a similar in-hospital mortality of 11.7%. 10 Our study demonstrated an increase in the in-hospital mortality rate for HF, both in Paraiba and in Brazil (65% and 30%, respectively), between 2008 and 2017. Godoy et al., 14 228