As the ESC 2021 approaches, a new edition of the German Heart Report is available (only in the German languange, known as the Deutsche Herzbericht). And it does not bode well: more and more people in Germany are suffering from heart failure and cardiac arrhythmias. Despite new treatment options, the care of these two diseases also remains a major challenge for cardiology.
The Heart Report is described as "a unique report in Europe, firmly established as an analytical tool for physicians, health care researchers, health care managers and media representatives"1 and it is the joint effort of the German Heart Foundation (Deutsche Herzstiftung), and the German Societies for Cardiology (DGK), Paediatric Cardiology (DGPK) and Thoracic, Cardiac and Vascular Surgery (DGTHG).
Heart failure has been the most frequent reason for in-patient hospitalisation in Germany for years - and the trend is rising. In the period from 2000 to 2019, the number of patients treated in German hospitals for heart failure grew by 40%, with the number increasing by 4.8% from 2018 to 2019 alone. A total of 487,247 hospitalisations were recorded for heart failure in 2019, as documented in the latest German Heart Report.
While the number of hospital admissions for heart failure has increased significantly in recent years, there has been a continued improvement in prognosis, or mortality, which in 2019 fell to its lowest level since 2011. "We believe this is due to newly available treatment options and the better establishment of guideline-based therapies," said Prof. Dr Stephan Baldus, President of the German Society of Cardiology.
Since 2014, two new drug classes have been added, which are having a clearly positive influence on the life expectancy of patients with heart failure, as has been impressively confirmed by large studies. For cardiologists, however, this is no reason to sound the all-clear. "We will continue to see increasing numbers of patients diagnosed with heart failure in the coming years," added Prof. Baldus, "Heart failure is often the consequence and end stage of many other cardiovascular diseases, the incidence of which is unfortunately also increasing."
One example of such an underlying condition of heart failure is mitral valve regurgitation. If it is treated, not only the likelihood of survival but also the quality of life of those affected improves enormously. Mitral valve insufficiency can now be treated very well by interventional means, especially if the risk of open-heart surgery would be too great.
The past 15 months in particular have shown through the COVID pandemic, as if under a ray of sun under a magnifying glass, that the close and careful care of heart failure patients is of enormous importance. "Unfortunately, we observed that patients suffering from heart failure were affected by a significant excess mortality last year, even if they did not have COVID," confirmed the DGK president, "This may certainly have been due to the fact that many interventions had to be postponed to relieve the pressure on intensive care units, but also because many sufferers did not come to the hospitals when their condition deteriorated for fear of infection."
The number of people in Germany suffering from cardiac arrhythmias has also increased in recent years: Between 1995 and 2015, the number of those who had to be admitted to hospital as inpatients because of cardiac arrhythmias increased by no less than 98.6%. "The cause of the significant increase must be sought, among other things, in the improved diagnostics and in the improved possibilities for medicinal and instrumental therapy of people with cardiac arrhythmias, but also in the continuing ageing of the population," added Prof. Baldus. Since 2015, the increase has slowed down significantly.
Despite the significant increase in the number of cases, the mortality rate has stagnated since 2011, because new treatment options are also available in the field of arrhythmias in cardiology, and their use is constantly being improved. For example, catheter ablation, a minimally invasive sclerotherapy of the heart, is not only a safe but also particularly effective method for treating cardiac arrhythmias. Above all, early use of this treatment option delays the progression and deterioration of the disease, as large studies have been able to show.
It is therefore not surprising that the number of these interventions in Germany increased by 40% from 2014 to 2019. "This shows a development that absolutely does justice to the increasing significance and importance of this therapy strategy," explained Prof. Baldus in no uncertain terms, adding that "one of the most serious consequences of atrial fibrillation can be a stroke. Thus, it is particularly important to detect this cardiac arrhythmia early and treat it as effectively as possible!"
In view of the current figures of the heart report, the DGK expert nevertheless draws a mixed conclusion. The fact that despite the increase in the incidence of the disease, mortality from heart failure and cardiac arrhythmias has been reduced is a great success story of cardiac medicine. "However, we must by no means rest on our laurels. Cardiovascular diseases have been the number one cause of death in Germany for years and by far, and due to the increasing number of cases there is no reason to believe that this will change in the foreseeable future," DGK President Baldus warned as a closing analysis.
1. The German Heart Foundation / Deutsche Herzbericht