Mortality from Heart Failure in Brazil: An epidemiological analysis (2014–2024)
DOI:
https://doi.org/10.33448/rsd-v14i10.49482Keywords:
Heart Failure, In-hospital Mortality, Hypertension, Health disparities, Time series.Abstract
Heart failure (HF) remains one of the leading causes of hospitalization and in-hospital mortality in Brazil, particularly in contexts of socioeconomic inequality. The main objective of this study was to analyze socioeconomic, age-related, and geographic disparities, as well as temporal trends in hospitalization and mortality rates from heart failure in Brazil (2010–2023), estimating the preventive effect of antihypertensive pharmacological coverage through multilevel panel models (Poisson/NegBin) with offset = log(population). In parallel, an integrative review (PubMed, Embase, Cochrane, Web of Science, and SciELO, 2010–2025) was conducted, including clinical trials, cohorts, and meta-analyses on antihypertensive classes and blood pressure targets related to reducing mortality or hospitalizations from HF. Results showed an average national increase of 1.9% per year in in-hospital lethality, more pronounced in the South region (+3.0%/year) and among older adults aged 60–79 years (≈2.1%/year). Men and women presented similar growth (+2.0%/year), while Black, Brown, and White groups ranged between 2.2% and 2.3%/year; the Indigenous population remained stable. It is concluded that, although HF hospitalizations have decreased, in-hospital lethality continues to expand heterogeneously across the territory. In this scenario, health policies that expand primary care coverage regionally, ensure equitable access to evidence-based therapies, and reinforce blood pressure control are necessary to transform pharmacological advances into tangible gains in survival and equity.
References
Albuquerque, D. C. et al. (2024). In-Hospital Management and Long-term Clinical Outcomes and Adherence in Patients With Acute Decompensated Heart Failure: Primary Results of the First Brazilian Registry of Heart Failure (BREATHE). J. Cardiac Fail. 30(5), 639-50.
Albuquerque, N. L. S. de et al. (2020). Determinantes sociais em saúde e internações por insuficiência cardíaca no Brasil. Rev. Esc. Enferm. USP. 54, e03641.
Alotaibi, H., Mohan, G., & Suresh, S. (2023). Hospitalization trend of cancer patients in Saudi Arabia: A ten-year retrospective study of patients admitted into hospitals from 2009–2018. Asian Pacific Journal of Cancer Prevention, 24(8), 2823–2827.
Arruda, V. L. et al. (2022). Trends in mortality from heart failure in Brazil: 1998-2019. Rev. Bras. Epidemiol. 25, e220021.
Barbosa, E. P. et al. O perfil de dispensação de anti-hipertensivos em uma farmácia popular na região Norte do Tocantins. Rev. FT Ciênc. Saúde. 29(145), 1–10.
Barreto, B. S. et al. 2024). Adesão ao tratamento anti-hipertensivo no Brasil: revisão sistemática. Ciênc. Saúde Colet. 29(3), 1013–27.
Brasil. (2024). Farmácia Popular do Brasil: medicamentos e indicações. Brasília. https://www.gov.br/saude/.
Cestari, V. R. F. et al. (2022). Spatial distribution of mortality for heart failure in Brazil, 1996–2017. Arq. Bras. Cardiol. 118(1), 41–51.
Coccina, F. et al. (2024). Risk of heart failure in ambulatory resistant hypertension: a meta-analysis. Hypertens. Res. 47, 1235–45.
Cunha, G. S. P. et al. (2025). Low education levels linked to increased mortality following acute heart failure hospitalization in Brazil. JACC: Heart Fail.
Deng, Y. et al. (2024). Sex differences in mortality and hospitalization in heart failure with preserved and mid-range ejection fraction: a systematic review and meta-analysis of cohort studies. Front. Cardiovasc. Med. 10, 1257335.
El Kadri, M. R. et al. (2019). Unidade Básica de Saúde Fluvial: um novo modelo da Atenção Básica para a Amazônia, Brasil. Interface (Botucatu). 23, e180613.
Ettehad, D. et al. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 387(10022), 957–67.
Heidemann, A. I. Jr. et al. (2025). Prevalence and mortality of heart failure stages in a free-living older adult population: data from the Brazilian Longitudinal Study of Adult Health. J. Am. Heart Assoc. 14(5), e038993.
Johnson, K. C. et al. (2019). Prevention of heart failure with diuretic-based antihypertensive treatment: reanalysis of the ALLHAT trial. J. Am. Heart Assoc. 8(8), e011961.
Keshvani, N. et al. (2023). Sex differences in long-term outcomes following acute heart failure hospitalization: findings from the Get With The Guidelines-Heart Failure registry. Eur. J. Heart Fail. 25(9), 1544–54.
Kizer, J. R. et al. (2005). Stroke reduction in hypertensive adults with cardiac hypertrophy randomized to losartan versus atenolol: the LIFE study. Hypertension. 45(1), 46–52.
Latado, A. L. (2025). Hospitalizations and in-hospital mortality from heart failure in Brazil: an updated overview. Arq. Bras. Cardiol. 122(6), e20250284.
Leckie, G., Browne, W. J., Goldstein, H., Merlo, J., & Austin, P. C. (2020). Partitioning variation in multilevel models for count data. Psychological Methods, 25(6), 787–801.
Lédo, A. P. O., Matos, S. M. A. Almeida, M. C., Fernandes, L. P. & Aras, R. (2025). Survival analysis and factors associated with mortality in heart failure patients in the ELSA-Brasil cohort. Arq. Bras. Cardiol. 124(2), 270–80.
Lédo, Ana Paula de Oliveira, Matos, Sheila Maria Alvim, Almeida, Maria da Conceição, Fernandes, Luciana Pereira & Aras, Roque. (2025). Survival Analysis and Factors Associated with Mortality in Heart Failure Patients in the ELSA-Brasil Cohort. Arq. Bras. Cardiol. 122(6), e20240705.
Lopes, R. D. et al. In-hospital management and long-term outcomes in patients with acute decompensated heart failure: primary results of the Brazilian BREATHE registry. J. Cardiac Fail., v. 31, p. 215–224, 2023.
Marcondes-Braga, F. G. et al. (2021). Atualização de tópicos emergentes da Diretriz Brasileira de Insuficiência Cardíaca – 2021. Arq. Bras. Cardiol. 117(suppl. 1), 1–120.
Matsumoto, C. et al. Systolic blood pressure lower than 130 mmHg in HFpEF: a systematic review and meta-analysis. Hypertens. Res., 2025.
Morettin, P. A. & Toloi, C. M. C. (2018). Análise de séries temporais. v.1. Editora Blücher.
Mulugeta, S. S., Muluneh, M. W., Belay, A. T., Moyehodie, Y. A., Agegn, S. B., Masresha, B. M., & Wassihun, S. G. (2022). Multilevel log linear model to estimate the risk factors associated with infant mortality in Ethiopia: Further analysis of 2016 EDHS. BMC Pregnancy and Childbirth, 22(597), 1–11.
Nascimento, E. G. S. et al. (2015). Um algoritmo baseado em técnicas de agrupamento para detecção de anomalias em séries temporais. In: Shitsuka, R. (2015). Estudos e Práticas de Aprendizagem de Matemática e Finanças com Apoio de Modelagem. Editora Ciência Moderna.
Oliveira, A. C. et al. (2020). Determinantes sociais em saúde e internações por insuficiência cardíaca no Brasil. Rev. Esc. Enferm. USP. 54, e03641.
Oliveira, G. M. M. de et al. (2024). Estatística Cardiovascular – Brasil 2023. Arq. Bras. Cardiol. 121(2), e20240079.
Pereira, A. S. et al. (2018). Metologia da pesquisa científica. [free ebook]. Santa Maria. Editora da UFSM.
Rahimi, K. et al. (2021). Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet. 397(10285), 1625–36.
Ribeiro, A. L. P. et al. (2023). Estatística cardiovascular – Brasil 2023. Arq. Bras. Cardiol. 120(supl. 2), 1–136.
Santos, S. C., Villela, P. B. & Oliveira, G. M. M. (2021). Mortality due to heart failure and socioeconomic development in Brazil between 1980 and 2018. Arq. Bras. Cardiol. 117(5), 944–51.
Savarese, G. & Lund, L. H. (2023). Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc. Res. 118(17), 3272–87.
WHO. (2023). Sustainable Development Goal 3: Good health and well-being. Genebra: Organização Mundial da Saúde (WHO). https://www.who.int/.
Wijesinghe, S. et al. (2025). Sex differences in heart failure: a step forward. Interv. Cardiol. 19, e18. https://doi.org/10.15420/icr.2024.30.
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