Heart Failure in North America
John E. A. Blair, Mark Huffman and Sanjiv J. Shah
Affiliation: San Antonio Military Medical Center/Wilford Hall Ambulatory Surgical Center, 2200 Bergquest Drive, Lackland AFB, TX 78236,USA.
Heart failure is a major health problem that affects patients and healthcare systems worldwide. Within the continent
of North America, differences in economic development, genetic susceptibility, cultural practices, and trends in risk
factors and treatment all contribute to both inter-continental and within-continent differences in heart failure. The United
States and Canada represent industrialized countries with similar culture, geography, and advanced economies and infrastructure.
During the epidemiologic transition from rural to industrial in countries such as the United States and Canada,
nutritional deficiencies and infectious diseases made way for degenerative diseases such as cardiovascular diseases, cancer,
overweight/obesity, and diabetes. This in turn has resulted in an increase in heart failure incidence in these countries,
especially as overall life expectancy increases. Mexico, on the other hand, has a less developed economy and infrastructure,
and has a wide distribution in the level of urbanization as it becomes more industrialized. Mexico is under a period of
epidemiologic transition and the etiology and incidence of heart failure is rapidly changing. Ethnic differences within the
populations of the United States and Canada highlight the changing demographics of each country as well as potential
disparities in heart failure care. Heart failure with preserved ejection fraction makes up approximately half of all hospital
admissions throughout North America; however, important differences in demographics and etiology exist between countries.
Similarly, acute heart failure etiology, severity, and management differ between countries in North America. The
overall economic burden of heart failure continues to be large and growing worldwide, with each country managing this
burden differently. Understanding the inter-and within-continental differences may help improve understanding of the
heart failure epidemic, and may aid healthcare systems in delivering better heart failure prevention and treatment.
Keywords: Heart failure, epidemiology, regions, North America.
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