# Prevalence and characterization of heart failure in Aragon, Spain (ICAR study)

## TL;DR

This study analyzed heart failure in Aragon, Spain, finding a 2.7% prevalence among adults, with rising hospital admissions and common comorbidities like hypertension and diabetes.

## Contribution

The study provides the first recent population-based estimate of heart failure prevalence and care patterns in Aragon, Spain.

## Key findings

- Heart failure prevalence in Aragon is 2.7% among adults and 14.6% in those over 75 years.
- Hospital-based diagnosis is common, with rising emergency visits and hospital admissions for HF between 2019 and 2023.
- Major comorbidities include hypertension (63.5%), dyslipidemia (48.9%), and obesity (39.5%).

## Abstract

Heart failure (HF) imposes a significant clinical and care burden. The ICAR study sought to address the absence of recent population estimates and an integrated approach to the diagnosis of HF in Spain, specifically in the region of Aragon.

Population-based, observational, retrospective, descriptive cross-sectional study conducted over a 5-year period (2019–2023) in Aragon. It included individuals residing in the region aged ≥18 years with HF and was based on BIGAN database.

We identified 30 677 individuals with HF (prevalence 2.7%). Prevalence increased with age (>75 years, 72.3%) and was higher in women (2.8% vs. 2.6%). Mean time since diagnosis was 6.6 years (standard deviation: 5.9). The main comorbidities were hypertension (63.5%); dyslipidemia (48.9%); obesity (39.5%); chronic kidney disease (35.4%); atrial fibrillation (34.0%); diabetes (32.3%); and anemia (30.6%). Diagnosis was primarily hospital-based: ∼33% were diagnosed exclusively during the hospital stay, ∼20% in primary care, and ∼45% across different levels of care. We observed a more than four-fold increase in hospital admissions in patients with HF and an approximately 45% increase in emergency visits for HF between 2019 and 2023. The main treatments prescribed were loop diuretics (57.5%), while the most common for HF were beta-blockers (47.4%), angiotensin receptor blockers (37.0%), mineralocorticoid receptor antagonists (23.5%), sodium-glucose cotransporter type 2 inhibitors (22.5%), angiotensin-converting enzyme inhibitors (17.7%), and sacubitril/valsartan (8.9%).

HF in Aragon shows high prevalence and complexity in an aging population with multiple pathologies, in the framework of a reactive care model characterized by in-hospital confirmation and rising resource utilization.

Infographic summarizing heart failure in Aragon, Spain, highlighting a 2.7 percent prevalence among adults and 14.6 percent among those aged seventy-five years and older. Major comorbidities in heart failure patients include hypertension at sixty-three point five percent, dyslipidemia at forty-eight point nine percent, obesity at thirty-nine point five percent, chronic kidney disease at thirty-five point four percent, atrial fibrillation at thirty-four percent, type two diabetes at thirty-two point three percent, and anemia at thirty point six percent. Treatment landscape bar graph shows highest usage for angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors and beta-blockers, with other treatments used less frequently. A pie chart displays diagnosis sites: hospital admission at thirty-two point six percent, primary care at nineteen point nine percent, combinations of care settings, and emergency department at three point one percent. Additional icons note increased hospital admissions and emergency department visits for heart failure.\n