The standard of care for patients with heart failure (HF) has improved considerably over the years. But the prognosis for patients has remained unchanged. New approaches in both acute and chronic settings are needed to further improve clinical outcomes and decrease the risk of cardiovascular (CV) death or re-hospitalisation due to HF.1,2
The heavy burden of heart failure
Affecting approximately 64 million people worldwide,3 HF is a chronic life-threatening disease in which the heart cannot pump enough blood around the body to meet its needs.4 Patients living with HF are up against some startling statistics, with approximately half of patients diagnosed expected to die within five years.5 It is the leading cause of avoidable hospitalisations worldwide.6 In fact, in the US, acute heart failure (AHF) is the most common CV cause for hospital admission, accounting for approximately one million hospitalisations in the US annually alone.7
A heightened risk of hospitalisation with heart failure
Regular and repeated hospitalisations are common for patients with HF, particularly those with AHF, an acute stage of HF that comes with heightened risk factors including:8
- Rapid onset
- Urgent treatment required
- High risk of re-hospitalisation
- CV death
Start heart failure treatment early
As we know, for patients with HF, time is of the essence. Given the severity of this chronic disease and the high risk of death, patients admitted to hospital for AHF require critical care. When life feels like a ticking clock, embracing opportunities to implement treatment strategies at the earliest possible moment to reduce the risk of repeated hospitalisation is therefore critical to improving standard of care and overall quality of life. Doing so can give people living with HF more time back.
In-hospital initiation of treatment for patients with HF
Hospitalisation presents an ideal time to evaluate evidence-based therapies for HF. The controlled hospital setting delivers a unique opportunity to coherently explain and implement an effective treatment programme for patients who have been stabilised after a hospitalisation for AHF. This empowers the patient, involving them in a strategy aimed at decreasing the risk of re-hospitalisation so that they spend less time in a hospital and more time enjoying life. Multiple studies have also shown that initiation and adherence are enhanced when evidence-based therapies are prescribed prior to hospital discharge.9,10
Early intervention and treatment in-hospital
To truly harness and promote early intervention, there is an opportunity to first highlight the safety and efficacy of in-hospital initiation of treatment for patients with HF and its role in reducing the increased risk of CV death and worsening of the condition. The early identification of treatment options in-hospital may prevent any exacerbating factors.8
Another important strategy that is utilised in-hospital to prevent re-hospilisation is creating a transition plan for patients. This may include establishment of specific follow-up plans, early post discharge visit, patient education and training or telemonitoring.8
Assessing the real-world value of treatment strategies
We must first understand and be able to quantify the impact of implementing treatments sooner and in a controlled setting. The aim is optimizing patient adherence. Therefore, we are assessing the effect early treatment can have on reducing incidences of CV death and worsening of HF in-hospital settings and after discharge.
Only by assessing the value of treatment strategies can we change the course of treatment and have the potential to improve outcomes for patients with HF.
We know what needs to be done and the next step is in our hands as we work to improve both the standard of care and clinical outcomes for the millions of patients worldwide living with HF.
1. Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB, Yusuf S, Swedberg K, Young JB, Michelson EL, Pfeffer MA, Candesartan in Heart failure: Assessment of Reduction in M and morbidity I. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation. 2007;116:1482-7.
2. Bello NA, Claggett B, Desai AS, McMurray JJ, Granger CB, Yusuf S, Swedberg K, Pfeffer MA and Solomon SD. Influence of previous heart failure hospitalization on cardiovascular events in patients with reduced and preserved ejection fraction. Circ Heart Fail. 2014;7:590-5.
3. 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.
4. Mayo Clinic. Heart failure; [cited 2020 July 30]. Available from: URL: https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142.
5. Mozaffarian D et al. Circulation. 2016 Jan 26;133(4):e38-360 and the CDC: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm.
6. World Heart Federation. Accelerate Change Together: Heart Failure Gap Review; 2020 [cited 2020 October 26]. Available from: URL: https://www.worldheart-federation.org/wp-content/uploads/HF-Gap-Review-Final.pdf.
7. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS, American Heart Association Council on E, Prevention Statistics C and Stroke Statistics S. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139:e56-e528.5. TBD
8. Farmakis, D, Parissis J, Lekakis J, Filippatos G. Acute Heart Failure: Epidemiology, Risk Factors, and Prevention. Rev Esp Cardiol. 2015; 68(3):245–248.
9. Gattis WA, O'Connor CM, Gallup DS, Hasselblad V, Gheorghiade M, Investigators I-H and Coordinators. Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure: results of the Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy in Heart Failure (IMPACT-HF) trial. J Am Coll Cardiol. 2004;43:1534-41.
10. Curtis LH, Mi X, Qualls LG, Check DK, Hammill BG, Hammill SC, Heidenreich PA, Masoudi FA, Setoguchi S, Hernandez AF and Fonarow GC. Transitional adherence and persistence in the use of aldosterone antagonist therapy in patients with heart failure. Am Heart J. 2013;165:979-986 e1.
Veeva ID: Z4-28688
Date of Preparation: November 2020