LAST UPDATED:
20 April 2023
Nearly 64 million people worldwide are living with heart failure (HF) and half will die within five years of diagnosis.1,2 As one of the world’s leading causes of disability and death with devasting impact on healthcare systems and the global economy3,4, it is crucial to develop and deliver innovative solutions to address the gaps that currently exist in the treatment of heart failure — millions of lives depend on advancing the treatment landscape of this disease.
Heart failure is a complex syndrome with current treatments helping to slow HF risks and progression in some, but not all patients5,6. These unmet medical needs underscore the urgency to increase awareness, early detection, and development of life-saving medicines to address these complexities with straightforward solutions.
Greater understanding of the drivers of HF will help to address the unique treatment needs across the spectrum of left ventricular ejection fraction (LVEF) and beyond.
Increasing our understanding of the different mechanisms that cause HF and how to approach them is an urgent but difficult challenge. HF is a complex syndrome often complicated by multiple interrelated diseases that may require different management strategies.7
There are several types of HF often defined by LVEF, a measurement of the percentage of blood leaving the heart each time it contracts, including: HF with reduced EF (HFrEF) (LVEF less than or equal to 40%), HF with mildly reduced EF (HFmrEF) (LVEF 41-49%) and HF with preserved EF (HFpEF) (LVEF greater than or equal to 50%).8,9 Approximately half of all patients with HF have HFmrEF or HFpEF, with few therapeutic options available.9-11
Discover the difference between HFpEF vs HFrEF and how we are seeking to uncover the mechanisms of HFpEF in the below video:
Additionally, people living with HF continue to face unacceptably high rates of hospitalisation and death, along with a progressive, debilitating decline in their capacity for physical activity.12-14 These physical symptoms limit patients’ daily activities and can result in poor quality of life, further emphasising the need for coordinated care and innovative treatment options.
As heart failure prevalence increases globally, there is a growing need for new innovative solutions. At AstraZeneca, we remain steadfast in our commitment to advancing patient centric science, while highlighting the importance of early intervention and delivering life-changing medicines for the millions living with heart failure and other cardiorenal
diseases.
Making the connection between cardiovascular, renal and metabolic (CVRM) conditions
HF is often complicated by interconnected CVRM conditions, making it even more difficult to manage.7 Up to one in five people with chronic kidney disease (CKD) will develop HF, the leading cardiovascular (CV) complication among this group of patients.15,16
Likewise, hyperkalaemia is also a common complication in those with HF as approximately 3-20% of patients with HF have 
the chronic or recurring condition.17 HF with LVEF above 50% is also highly prevalent in patients with hypertension, type-2 diabetes (T2D), obesity, or metabolic syndrome.10,11,18-20
Research has revealed a significant hereditary component to HF, and variants in the genome have been identified to play a role in the development of the disease.21 We know that cardiomyopathies, a heterogeneous group of heart muscle diseases that include hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and transthyretin amyloidosis mutations among others, are an important cause of HF.22
This further underlines the importance of connecting the dots between HF’s co-morbidities and disease drivers if we are to truly understand and treat the disease itself.
Changing the course of heart failure
To overcome these challenges and, ultimately, improve outcomes for patients, we must continue to accelerate earlier detection and coordinated care that can help address the complexities of heart failure across the broad spectrum of the disease.
HF guidelines are an important part of the solution as they help provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with HF. The 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure23 and more recently the 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guidelines for the Management of Heart Failure provide insights on the distinct types of HF, how to approach the disease, and how to diagnose and intervene early.11 Effective implementation is key to saving lives.
The complexities of heart failure require members of the medical community to think and act holistically with a patient-centered approach. We must all drive to the common goal of understanding the nuances of the heart failure patient journey to advance earlier detection, intervention and access to innovative treatment approaches that will help improve outcomes for patients.
Early intervention, detection, and development of life-saving medications are imperative to push toward the goal to prevent, stop and potentially reverse HF. By increasing awareness of the nuances of HF and the adhering to the latest treatment guidelines, patients can benefit from a treatment plan that aligns with the progression and complexity of their disease, along with novel therapies, that have the potential to change the course of disease.
You may also like
References
1. Vos T et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2017; 390(10100):1211–59.
2. Mozaffarian D et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016; 133(4):e38-360.
3. World Health Organization [Internet]. WHO reveals leading causes of death and disability worldwide: 2000-2019; 2020 [cited 2022 August 1]. Available from: https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019#:~:text=Heart%20disease%20has%20remained%20the,nearly%209%20million%20in%202019.
4. Azad N, et al. Management of chronic heart failure in the older population. J Geriatr Cardiol. 2014; 11(4):329–37.
5. Hobbs FD, et al. Heart failure in general practice. BMJ 2000; 320(7235):626–29.
6. Machaj F, Dembowska E, Rosik J, Szostak B, Mazurek-Mochol M, Pawlik A. New therapies for the treatment of heart failure: a summary of recent accomplishments. Ther Clin Risk Manag. 2019 Jan 22;15:147-155. doi: 10.2147/TCRM.S179302. PMID: 30774351; PMCID: PMC6348963.
7. Savarese G, et al. Heart failure drug titration, discontinuation, mortality and heart failure hospitalization risk: a multinational observational study (US, UK and Sweden). Eur J Heart Fail. 2021; doi: 10.1002/ejhf.2271. Epub ahead of print. PMID: 34132001
8. Cleveland Clinic [Internet]. Heart failure; [cited 2022 Aug 1] Available from: https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure
9. McDonagh T, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;00:1-128. (Epub ahead of print). [cited 2022 Aug 1]. Available from: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab368/6358045
10. Dunlay SM, et al. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol 2017;14(10):591–602.
11. Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-421.
12. Savarese G, et al. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017;3(1):7-11.
13. Mayo Clinic [Internet]. Heart failure; 2021 [cited 2022 Aug 1]. Available from: https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142.
14. World Heart Federation. [Internet]. Accelerate Change Together: Heart Failure Gap Review; 2020 [cited 2021 Aug 25].
15. House AA et al. Heart failure in chronic kidney disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 95(6):1304–17.
16. Segall L et al. Heart failure in patients with chronic kidney disease: A systematic integrative review. Biomed Res Int 2014; 2014:937398.
17. Tromp J, van der Meer P. Hyperkalaemia: Aetiology, epidemiology, and clinical significance. Eur Heart J Suppl 2019; 21(Suppl A):A6-A11.
18. Triposkiadis F, et al. Reframing the association and significance of co-morbidities in heart failure. Eur J Heart Fail 2016;18(7):744–58.
19. Ceriello A, Catrinoiu D, Chandramouli C, Cosentino F, Dombrowsky AC, Itzhak B, Lalic NM, Prattichizzo F, Schnell O, Seferović PM, Valensi P, Standl E; D&CVD EASD Study Group. Heart failure in type 2 diabetes: current perspectives on screening, diagnosis and management. Cardiovasc Diabetol. 2021 Nov 6;20(1):218. doi: 10.1186/s12933-021-01408-1. PMID: 34740359; PMCID: PMC8571004.
20. Tourki B, Halade GV. Heart Failure Syndrome With Preserved Ejection Fraction Is a Metabolic Cluster of Non-resolving Inflammation in Obesity. Front Cardiovasc Med. 2021 Aug 2;8:695952. doi: 10.3389/fcvm.2021.695952. PMID: 34409075; PMCID: PMC8367012.
21. Czepluch FS, Wollnik B, Hasenfuß G. Genetic determinants of heart failure: facts and numbers. ESC Heart Fail. 2018 Jun;5(3):211-217. doi: 10.1002/ehf2.12267. Epub 2018 Feb 19. PMID: 29457878; PMCID: PMC5933969.
22. Heart.org [Internet]. What Is Cardiomyopathy in Adults? [cited 2022 Aug 1]. Available from: https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults
23. European Society of Cardiology [Internet]. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.
Veeva ID: Z4-54193
Date of preparation: April 2023