Abstract
BackgroundThe Global Burden of Disease (GBD) does not produce estimates of heart failure (HF) since this condition is considered the common end to several diseases (i.e., garbage code). This study aims to analyze the interactions between underlying and multiple causes of death related to HF in Brazil and its geographic regions, by sex, from 2006 to 2016.MethodsDescriptive study of a historical series of death certificates (DCs) related to deaths that occurred in Brazil between 2006 and 2016, including both sexes and all age groups. To identify HF as the underlying cause of death or as a multiple cause of death, we considered the International Classification of Diseases (ICD) code I50 followed by any digit. We evaluated the deaths and constructed graphs by geographic region to compare with national data.ResultsWe included 1,074,038 DCs issued between 2006 and 2016 that included code I50 in Parts I or II of the certificate. The frequency of HF as the multiple cause of death in both sexes was nearly three times higher than the frequency of HF as an underlying cause of death; this observation remained consistent over the years. The Southeast region had the highest number of deaths in all years (about 40,000 records) and approximately double the number in the Northeast region and more than four times the number in the North region. Codes of diseases clinically unrelated to HF, such as diabetes mellitus, chronic obstructive pulmonary disease, and stroke, were mentioned in 3.11, 2.62, and 1.49% of the DCs, respectively.ConclusionsWhen we consider HF as the underlying cause of death, we observed an important underestimation of its impact on mortality, since when analyzed as a multiple cause of death, HF is present in almost three times more deaths recorded in Brazil from 2006 to 2016. The mentioning of conditions with little association with HF at the time of the death highlights the importance of HF as a complex syndrome with multiple components that must be considered in the analysis of mortality trends for implementation of public health management programs.
Highlights
The Global Burden of Disease (GBD) does not produce estimates of heart failure (HF) since this condition is considered the common end to several diseases
The authors highlighted that the evaluation of the underlying causes of death has an important limitation because HF-related codes are not selected in the presence of other diseases such as ischemic heart disease (IHD), resulting in an underestimation of death related to HF, urging a study of HF included as multiple causes of death [2]
We identified the occurrence of HF listed in the Death certificates (DC) as the presence of code I50 of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) listed in Parts I or II of the certificate
Summary
The Global Burden of Disease (GBD) does not produce estimates of heart failure (HF) since this condition is considered the common end to several diseases (i.e., garbage code). This study aims to analyze the interactions between underlying and multiple causes of death related to HF in Brazil and its geographic regions, by sex, from 2006 to 2016. In Brazil, the disability-adjusted life years (DALYs) lost due to ischemic heart disease (IHD), the main component of CVD mortality, ranged from 771.2 (95% UI 679.4–866.3) per 100,000 in Amazonas to 2416.2 (95% UI 2176.7–2686.2) per 100,000 in Rio de Janeiro, a 103.2% difference within the country, with important regional variations [1]. Estimates by the GBD regarding heart failure (HF) are unavailable since HF – a common end to several diseases – is frequently used as a garbage code in which death due to HF is redistributed by the conditions responsible for its occurrence. The authors highlighted that the evaluation of the underlying causes of death has an important limitation because HF-related codes are not selected in the presence of other diseases such as IHD, resulting in an underestimation of death related to HF, urging a study of HF included as multiple causes of death [2]
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