Heart failure‐attributed mortality in Europe, 2012–2021

Abstract Aims Heart failure (HF) is a leading cause of cardiovascular mortality worldwide. However, comprehensive and updated assessments of HF‐attributable mortality trends across Europe are limited. The aim of this study was to evaluate HF‐attributed mortality trends in Europe between 2012 and 2021, examining variations by age, sex, and European region. Methods and results We extracted HF‐attributed mortality data from the World Health Organization (WHO) mortality dataset for 2012–2021. Age‐adjusted mortality rates (AAMRs) were analysed using joinpoint regression modelling, expressed as average annual percent change (AAPC) with 95% confidence intervals (CIs). A parallelism test compared trend differences across groups. To explore contributors to HF‐attributable mortality, we analysed the mean alcohol consumption and the age‐adjusted prevalence and trends of smoking habit, arterial hypertension (HTN), obesity and type 2 diabetes mellitus (DM) using the WHO non‐communicable diseases dataset (2012–2021). From 2012 to 2021, 4 872 634 individuals (2 084 521 men and 2 788 113 women) died due to HF, equating to 11 522 deaths per 100 000 population. Overall, the AAMR increased (AAPC: +0.4% [95% CI 0.3–0.5], p < 0.001), with a significantly greater increase in men compared to women ( p for parallelism = 0.02). HF‐attributable mortality trend had a higher increase among patients aged less than 70 years compared to those aged 70 years or older ( p for parallelism = 0.001). Regionally, AAMRs increased in Western (AAPC: +1.2% [95% CI 1.0–1.4], p < 0.001), Eastern (AAPC: +0.9% [95% CI 0.7–1.0], p < 0.001) and Northern Europe (AAPC: +0.5 [95% CI 0.3–0.6], p < 0.001) while plateaued in Southern Europe (AAPC: +3.2% [95% CI −3.2 to 10.1], p = 0.28). A similar increase was observed in the trend for AAMR in HF‐attributable mortality among subjects died due to HF with reduced or preserved ejection fraction ( p for parallelism = 0.18). During the same period, the age‐adjusted prevalence of overweight, obesity and DM rose, while HTN, smoking habit and alcohol consumption decreased. Conclusions Heart failure‐attributed mortality in Europe increased between 2012 and 2021. Substantial disparities persist across European regions and countries.