World Heart Day | More heart failure in the East

In the shadow of the waste dumps: According to forecasts, the population in Mansfeld-Südharz is expected to shrink by 21.1 percent between 2020 and 2040. The proportion of older people is constantly increasing. Photo: dpa/Jan Woitas Poverty makes you sick - this motto now proves its accuracy based on the distribution of heart failure in the population in this country. In its current health atlas, the AOK Scientific Institute (Wido) has looked at this aspect in more detail. The report was published last week.

In Germany, around 3.2 million people lived with heart failure in 2024. Around 5.5 percent of the population aged 30 and over are affected. But the spread depending on the region ranges from 6.8 percent to 4.4 percent. The highest values ​​can be found in economically and socially disadvantaged regions. There are three eastern German federal states: Saxony-Anhalt (8.9 percent), Saxony (7.9 percent) and Thuringia (8.5 percent). If we look even more closely, namely at the level of the 400 districts and independent cities, Mansfeld-Südharz in Saxony-Anhalt reaches a value of 13.9 percent of the population. At the top end of the scale is Frankfurt am Main with 2.8 percent.

Socioeconomic risk factors cannot be compensated for by medicine, nor can they be compensated for by health policy alone.

A very low prevalence of heart failure can also be found in many districts around Hamburg and Munich, as well as in the Rhine-Main area and in southern Baden-Württemberg. But when it comes to the highest values, things get even more interesting at the district level: In addition to many eastern German districts, these also include several in northern and eastern Bavaria. According to Wido managing director Helmut Schröder, only a small part of the regional differences can be attributed to age and gender structures.

The risk of heart failure increases sharply with age. This is most evident in the numbers of very old people: of those over 90, 35 percent of men and 30 percent of women suffer from it. Predecessors or risk factors for this are high blood pressure, coronary heart disease (CHD) including heart attacks and other heart diseases, including valve defects or muscle inflammation.

The social connection becomes clearer for other, partly avoidable risk factors, including smoking and type 2 diabetes. And here the genders are affected differently: the proportion of smokers among men has always been significantly higher than that among women. High blood pressure is also diagnosed earlier in men than in women. The proportion of people who are treated for hypertension is analogous to the proportion of heart failure patients. If the first value is relatively high, this is also the case with heart failure.

What to do now? In any case, it is advisable to place more emphasis on prevention when it comes to medical care in the particularly affected regions, as is the Wido recommendation. World Heart Day this Tuesday draws attention to exactly this focus, more specifically to eight important risk factors that not only everyone should pay attention to themselves, but which also receive great attention in medical care: high blood pressure, high blood lipid levels, obesity, smoking, diabetes. Add to this a healthy diet, enough sleep and exercise.

That sounds simple, but it's a big deal: Older people in particular, whose family and specialist practices are becoming increasingly difficult to reach, are likely to be more difficult to convince to make lifestyle changes. What remains in the background are the poorer values ​​for income, education and employment in the regions mentioned compared to industrially dominated federal states in the West. Those who earn little or have to live on state transfer payments, who have a low school qualification or who are or have been repeatedly unemployed are less likely to concern themselves with their own fitness or celebrate healthy food. Socioeconomic risk factors cannot be compensated for by medicine, nor can they be compensated for by health policy alone. But it is precisely they that have a significant influence on the disease burden in the regions.

Worldwide, up to two percent of the population suffers from heart failure, and the prevalence among older people is generally increasing - to over ten percent of all people over 75 years of age. Up to a quarter of all people are at risk of being diagnosed during their lifetime. While the risk factors for such a disease in industrialized nations have already been named, there are some specific ones for the global south, including infectious heart diseases - including in connection with tuberculosis.

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