East Germany reports higher rates of heart failure

Article written by Gary Finnegan

Thirty years after German reunification, stark differences remain in the health of citizens in the former East Germany and former West Germany.

A new study published by the European Society of Cardiology, highlights the variation in heart failure rates on either side of the old divide.

Eastern Germany has many more hospitalisations for heart failure compared to western Germany despite all citizens sharing a national healthcare system. Heart failure is the most common reason for hospital admissions and is responsible for a large part of the total health expenditure on cardiovascular diseases throughout the western world.

A previous study reported that the absolute number of heart failure-related hospitalisations increased by 65% in Germany between 2000 and 2013. ‘Before reunification in 1990, East and West Germany not only had very different social and economic systems but also had distinct healthcare systems,’ said study author Prof Marcus Dörr of University Medicine Greifswald, Germany.

The new study analysed whether the shift to a shared system affected the number and duration of hospitalisations and in-hospital mortality due to heart failure in western and eastern Germany from 2000 to 2017. The researchers also examined whether the rise in heart failure-related hospitalisations occurred equally in both parts of Germany.

Data were obtained from Federal Health Monitoring, an annual census of routine inpatient data. The researchers found that the absolute number of hospitalisations due to heart failure continued to increase dramatically across Germany and there were substantial differences between regions.

In 2000 to 2017, the number of hospital admissions due to heart failure throughout Germany increased continuously by 93.9% (from 239,694 to 464,724 cases). This increase was much stronger in the east than in the west (+118.5% vs. +88.3%) and was higher in each of the federal states in the former East Germany than in every single state in former West Germany.

During the same period, there was only a slight increase in the number of hospitalisations for other diagnoses all over Germany. Heart failure was the leading cause of disease-related hospitalisation in Germany in 2017, again with clear differences between east and west (increase from 1.5% to 2.9% in the east vs. 1.4 % to 2.2 % in the west).

While the overall length of hospital stays decreased continuously over time, the total number of heart failure-related hospital days increased by 50.6% in East and by 34.6% in West Germany.

Professor Dörr said the differences cannot be explained by the different age structures in east and west. ‘A possible explanation for our findings may be found in the varied prevalence of risk factors that impact heart failure development, progression and thereby hospitalisation,’ said Professor Dörr. “In fact, previous research has shown that, for example, hypertension, diabetes, and obesity are much more common in East than in West Germany.’