https://orcid.org/0000-0003-2033-2494
Introduction and perspectives
Heart failure (HF) has become a major concern in cardiovascular medicine in developed and emergent countries, and Mexico is no exception. In 2021, Bozkurt et al.1 defined it as ‘a clinical syndrome characterized by typical signs and symptoms caused by structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest during stress’.
The prevalence of HF in Mexico has been on the rise, primarily due to an increase in risk factors such as hypertension and diabetes and lifestyle changes, presenting dual challenge and opportunity, reflecting both the burdens it imposes on the healthcare system and individuals and the potential for improvement through strategic interventions (Figure 1).
Main challenges and opportunities on the management of heart failure in Mexico
One of the primary drivers of HF in Mexico is the aging demographic. As the population ages, the incidence of cardiovascular diseases, including HF, tends to increase. With a growing elderly population, there is a higher prevalence of risk factors such as hypertension and coronary artery disease, both of which significantly contribute to the development of HF.
Unfortunately, there are just small registries of México about the most frequently related aetiologies. Nevertheless, some efforts have been made to recognize and standardize diagnosis, follow-up, and treatment of HF.
In 2004, Orea et al. began the efforts to publish a national registry in HF, identifying that the most common comorbidities associated with the development of HF were type 2 diabetes present in 40.1% and ischaemic heart disease in 36.4% of patients included.
In 2020, a large retrospective cohort from the National Institute of Cardiology was published, including 21 042 patients admitted to the coronary care unit during a period of almost 13 years, all of them with acute HF, identifying that the most common cause of HF hospitalization was related to acute coronary syndromes (43%), followed by chronic decompensated HF (33.7%) and hypertensive HF (11.8%), showing high rates of history of hypertension (53.5%), diabetes (37.0%), smoking (47.9%), and previous ischaemic heart disease (23.2%).2 This information correlates with international data published by the Global Burden of Disease study, showing that the most common causes of HF are related to ischaemic heart disease and hypertensive heart disease.3
In 2021, the Mexican Society of Cardiology, in collaboration with the National Association of Mexican Cardiologists, published the First Mexican Statement in Heart Failure as the biggest effort registered to date to spread the importance of appropriate diagnosis and management of HF in our country.4
Challenges and opportunities
The increasing rates of lifestyle-related risk factors further exacerbate the HF epidemic in Mexico. Sedentary lifestyles, unhealthy dietary patterns, and a rise in obesity rates contribute to the higher incidence of conditions like diabetes and hypertension, which are major predisposing factors for HF.
The prevalence of chronic non-communicable diseases, particularly diabetes, hypertension, and obesity, has increased their prevalence in the last 15 years. According to official information in México, reported by the National Institute of Geography and Statistics (INEGI) and by the latest National Survey of Health and Nutrition (ENSANUT), in 2022, cardiovascular diseases (including HF) represented 23.5% of all causes of death. In addition, according to cardiovascular risk factors, 75.2% of people older than 20 years have overweight and obesity.
Diabetes prevalence is about 18.4% of the population older than 20, and 31.7% of Mexican people ignore its diagnosis. On the other hand, hypertension has a prevalence of 29.4%. Its importance lies as part of the risk factors of coronary heart disease and, with it, of HF, which allows us to predict that, in the following years, HF will have exponential growth. Therefore, it is imperative to generate a greater impact to prevent it.
Recently, since 2022, a group of HF experts in Mexico fomented HF knowledge by creating the first congress in México about HF, concentrating a great effort in bringing national and international experts with one principal objective: diffusion of evidence-based science relevant to this pathology. One of the most important results was the creation of the Mexican Association for Heart Failure.
In Mexico, the national health system is composed of three main dependencies, each with different economic capacities. Because of that, there is a large heterogeneity in the capacity to care for this disease within the different health dependencies. On the one hand, there are hospitals with great economic capacities, concentrating a large number of resources and implementing innovative strategies as part of the follow-up, such as mobile applications, and therefore with not only full availability to provide the treatment recommended by the HF guidelines but also the possibility to implant structural cardiac devices, such as MitraClip; left ventricular assist device, as part of bridge therapy to cardiac transplantation; and of course, cardiac transplantation itself.5
Nevertheless, heart transplantation is far from being a reality. In 1988, the first heart transplant was performed. According to information from the National Transplant Center (CENATRA), 680 heart transplants have been performed by 2022.6 In 2023 alone, there are records of 30 patients waiting to receive a heart transplant, and 37 transplants have been performed to date.
Therefore, the healthcare infrastructure in Mexico faces challenges in dealing with the rising burden of HF. Limited resources, especially in rural areas, pose barriers to early detection and effective management. Access to healthcare services, including diagnostic tools and medications, is often uneven, resulting in delayed or inadequate treatment.
Strengthening healthcare systems, particularly in terms of accessibility and affordability, is imperative to improve outcomes for individuals with HF.
Preventive measures play a pivotal role in mitigating the impact of HF. Public health initiatives that focus on lifestyle modifications, early detection of risk factors, and promoting regular health check-ups can contribute significantly to reducing the incidence of HF.
Additionally, investing in cardiovascular research and innovation can lead to advancements in treatment modalities, improving the overall outlook for individuals living with HF.
Addressing this public health concern requires a comprehensive approach that encompasses preventive measures, improved healthcare infrastructure, and ongoing research initiatives. By prioritizing these aspects, Mexico can work towards reducing the burden of HF and enhancing the overall cardiovascular health of its population.
One of the biggest challenges is related to the urbanization process since it has not been homogeneous throughout the country; this favours the poor availability of tertiary clinics, and combined with the poor distribution of resources and its centralization to bigger cities, the capacity for diagnosis and treatment is limited in marginalized cities with fewer resources.
Conclusion
Heart failure in Mexico is a complex and multifaceted disease influenced by demographic changes, lifestyle factors, and healthcare system challenges. This is why, without a doubt, the biggest challenge we face is to begin to characterize, promptly, the epidemiological profile of this pathology, its prevalence, and its impact on quality of life and economic index so that health institutions guarantee the adequate availability of resources for prompt and optimal care.
Declarations
Disclosure of Interest
All authors declare no disclosure of interest for this contribution.
