Heart failure in the Portuguese population aged ≥50 years: prevalence and phenotypes in the PORTHOS study.

BACKGROUND AND AIMS: Heart failure (HF) is a major global health burden, yet its true prevalence remains uncertain due to heterogeneous study designs and evolving diagnostic criteria. The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) aimed to estimate the prevalence and phenotypic distribution of HF in community-dwelling adults aged ≥50 years in mainland Portugal.

METHODS: PORTHOS was a cross-sectional, population-based study with a two-stage design. Stage 1 randomly selected community-dwelling individuals aged ≥50 years via structured interviews and point-of-care N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. Individuals with NT-proBNP ≥125 pg/mL and/or a self-reported HF diagnosis, plus a random 5% of screen-negatives, proceeded to stage 2. This confirmatory stage included clinical assessment, electrocardiogram, and echocardiography. HF diagnosis required the presence of symptoms, NT-proBNP ≥125 pg/mL, and echocardiographic criteria. HF was defined as per the 2021 ESC and HFA-PEFF guidelines.

RESULTS: Of 6189 participants, 2249 screened positive and 1136 were diagnosed with HF. The estimated HF prevalence was 16.54%, increasing with age (from 4.01% in 50-59 years old to 30.68% in those ≥70) and higher in females than males (21.00% vs 10.47%). Notably, 93.4% had HF with preserved ejection fraction (HFpEF), and 90% were previously undiagnosed. HFpEF was independently associated with older age, female sex, type 2 diabetes, atrial fibrillation, and dyslipidaemia.

CONCLUSIONS: HF affects approximately one in six Portuguese adults aged ≥50 years, with HFpEF accounting for over 90% of cases, most previously undiagnosed. These findings support NT-proBNP-based screening combined with echocardiographic evaluation to improve early HF detection in ageing populations.