DÄ internationalArchive34-35/2009Heart Failure: the Commonest Reason for Hospitalization in Germany—Medical and Economic Perspectives: In reply

Correspondence

Heart Failure: the Commonest Reason for Hospitalization in Germany—Medical and Economic Perspectives: In reply

Dtsch Arztebl Int 2009; 106(34-35): 566. DOI: 10.3238/arztebl.2009.0566

Neumann, T; Biermann, J

LNSLNS We support Professor Nizze's request for more comprehensive explanation of the data situation, especially with regard to the etiology of heart failure.

The results from population based, longitudinal studies from industrialized countries show that ischemic myocardial damage accounts for by far the largest proportion in the etiology of heart failure, at 70% (1, 2). Improved treatment options and falling death rates due to myocardial infarction will contribute to high rates of ischemic myocardial damage in the future. A further 10% are due to physical defects and cardiomyopathies, according to the European Society of Cardiology (2).

Unfortunately, the available datasets from the Federal Statistical Office do not provide an opportunity for a selective presentation of the etiology in Germany. On the basis of the statistical data for mortality and hospitalization, differentiation is possible only for congestive heart failure (I50.0), left-sided heart failure (I50.1), and not further specified heart failure (I50.9). A differentiation of right-sided heart failure, left-sided heart failure, and global heart failure cannot be made from the data. With regard to the disease costs, the most detailed option to represent these is from a global perspective to the level of three digits after the comma. On the basis of the available datasets, further differentiation of heart failure is currently not possible in terms of health economics. However, we will bear in mind Professor Nizze's comment and try to implement his suggestions in future projects.

Andersohn et al point out that the German standard population that we used (Germany 1987) is incorrect because it does not enable comparisons between the sexes. We do not share this view, even though this argument by the Berlin group is justified. In our view, using the standard population as in our publication is just as justifiable as using the suggested older European standard population. Our study is based on national data, and for this reason the selected German standard population of 1987 is entirely appropriate. Additionally, the standard population used by in our article is also used officially for standardizing the data. We selected the standard population in our study by following hospital statistics from the Federal Statistical Office (3).

We still think the argument brought forward by Andersohn et al, with regard to the limited comparability between the sexes, is justified. However, owing to the specific characteristics of the individual standard populations, we did not wish to refer to one of the standard populations under discussion as a correct or incorrect standardization. This would require a more differentiated perspective, to which our colleagues' comment has made a valuable contribution.
DOI: 10.3238/arztebl.2009.0566


PD Dr. med. Till Neumann
Janine Biermann

PD Dr. med. Dipl.-Kfm. T. Neumann
Klinik für Kardiologie
Universitätsklinikum Essen
Hufelandstraße 55
45122 Essen
E-Mail: till.neumann@uk-essen.de

Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Fox KF, Cowie MR, Wood DA et al.: Coronary artery disease as the cause of incident heart failure in the population. Eur Heart J 2001; 22: 228–36. MEDLINE
2.
Dickstein K, Cohen-Solal A, Filippatos G et al.: ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 2008; 29: 2388–442. MEDLINE
3.
Statistisches Bundesamt: Fachserie 12 / Reihe 6.2.1. Diagnosedaten der Patienten und Patientinnen in Krankenhäusern (einschließlich Sterbe-, und Stundenfälle) 2007. Wiesbaden 2008.
4.
Neumann T, Biermann J, Neumann A et al.: Heart failure: the commonest reason for hospitalization in Germany—medical and economic perspectives [Herzinsuffizienz: Häufigster Grund für Kranken­haus­auf­enthalte. Medizinische und ökonomische Aspekte]. Dtsch Arztebl Int 2009;106: 269–75. VOLLTEXT
1. Fox KF, Cowie MR, Wood DA et al.: Coronary artery disease as the cause of incident heart failure in the population. Eur Heart J 2001; 22: 228–36. MEDLINE
2. Dickstein K, Cohen-Solal A, Filippatos G et al.: ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 2008; 29: 2388–442. MEDLINE
3. Statistisches Bundesamt: Fachserie 12 / Reihe 6.2.1. Diagnosedaten der Patienten und Patientinnen in Krankenhäusern (einschließlich Sterbe-, und Stundenfälle) 2007. Wiesbaden 2008.
4. Neumann T, Biermann J, Neumann A et al.: Heart failure: the commonest reason for hospitalization in Germany—medical and economic perspectives [Herzinsuffizienz: Häufigster Grund für Kranken­haus­auf­enthalte. Medizinische und ökonomische Aspekte]. Dtsch Arztebl Int 2009;106: 269–75. VOLLTEXT