Epidemiology of heart failure in primary care in Madeira: the EPICA-RAM study.
Chronic heart failure (CHF) is a serious public health problem all over the world. CHF has a high prevalence, affecting mainly the elderly, and causes severe disability and social and economic costs.


OBJECTIVE
To estimate the prevalence of chronic heart failure in the Autonomous Region of Madeira in 2001.


METHODS
This was a community-based epidemiological survey involving subjects attending primary care centers selected by a combined two-stage sampling and stratifying procedure. General practitioners (GPs) randomly selected in proportion to the population of each municipality evaluated subjects aged over 25 years attending primary care centers, recruited consecutively and stratified by age. CHF cases were identified according to the Guidelines of the European Society of Cardiology for CHF diagnosis.


RESULTS
Six hundred and eighty-six eligible subjects were evaluated by 30 GPs; 60 patients with CHF were identified. The overall prevalence and 95 % CI of CHF in Madeira was 4.69 % (2.91 % to 6.46 %), 3.53 % in males (0.81 % to 6.26 %), and 5.58 % in females (3.37 % to 7.79 %). CHF prevalence increases with age: 1.24 % (0.00 % to 2.96 %) in the 25 to 49-year-old group, 6.17% (1.31 to 11.03 %) in those aged 50 to 59 years, 7.62 % (0.75 to 14.49 %) in those aged 60 to 69 years, 13.32 % (7.99 % to 14.49 %) in the 70 to 79-year-old group, and 14.34 % in the group over 80 years old (7.59 % to 21.09 %). The prevalence of CHF due to systolic dysfunction was 0.76 % and 2.74 % with normal systolic function.


CONCLUSIONS
The overall prevalence of CHF in Madeira was similar to that of mainland Portugal, and slightly higher than that of other European studies. Overall CHF prevalence increases sharply with age. The prevalence of CHF with preserved systolic ventricular function was similar to that reported by other recent European studies. The prevalence of CHF due to systolic dysfunction was much lower. The differences found may correspond to differences in methodology rather than actual differences in the population. CHF with left ventricular systolic dysfunction seems to be rare in primary care in Madeira. This may be related to the different public health organization in Madeira, and deserves further evaluation.
Ceia
Fátima
F
Grupo de Investigação EPICA, Portugal. fatima.ceia@sapo.pt
Fonseca
Cândida
C
Azevedo
Isabel
I
Mota
Teresa
T
Morais
Humberto
H
Matias
Fernando
F
Costa
Catarina
C
Gouveia-Oliveira
António
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies