Facts and numbers on epidemiology and pharmacological treatment of heart failure with preserved ejection fraction

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a major and growing public health problem. Epidemiologic studies demonstrated that heart failure (HF) can be clinically diagnosed in patients with normal or preserved left ventricular ejection fraction. These patients are therefore termed as having HFpEF. In the past, this was often called diastolic HF. Because of the permanent increase of the prevalence of HFpEF during the past decades, HFpEF now accounts for more than 50% of the total HF population. There are uncertainties and debates regarding the definition, diagnosis, and pathophysiology with the consequence that all outcome trials performed so far used criteria for inclusion and exclusion that were not consistent. These trials also failed to document improved prognosis. Recent smaller proof‐of‐concept or Phase II clinical trials investigating different pathophysiological approaches with substances such as the neprilysin inhibitor–angiotensin receptor blocker− combination (LCZ 696), ranolazine, or ivabradine were successful to improve biomarkers, haemodynamics, or functional capacity. Future trials will need to document whether also prognosis can be improved.

Muscle wasting and sarcopenia in heart failure and beyond: update 2017

“…Cardiovascular disease is a highly prevalent group of disorders including chronic heart failure (CHF) in the elderly population with numbers affected reaching approximately 2% of the population . CHF prevalence increases strongly with age and its rates double approximately every 10 years in male and every 7 years in female patients after 55 years of age; hence, the majority of CHF patients are elderly to very old and the numbers of affected people are expected to rise with the increased overall life expectancy, particularly in Asia .…”

“…Overall, CHF leads to a significant morbidity, institutionalization and mortality, as well as to an enormous socio‐economic burden and studies focusing on the care and needs of the patients are desirable . The most common form of CHF is heart failure with preserved ejection fraction . Interestingly, heart failure with preserved ejection fraction patients demonstrate a high prevalence of sarcopenic obesity .…”

“…7 The most common form of CHF is heart failure with preserved ejection fraction. 2 Interestingly, heart failure with preserved ejection fraction patients demonstrate a high prevalence of sarcopenic obesity. [8][9][10] In advanced stages of CHF, a loss of skeletal muscle mass (sarcopenia) is commonly observed which contributes to reduced exercise capacity and frailty, [11][12][13] which may represent a risk marker for adverse outcomes in CHF.…”

The functional consequences of sodium channel NaV1.8 in human left ventricular hypertrophy

“…1,2 It has been reported that LVH can potentially increase the incidents of congestive heart failure (HF) and sudden cardiac death. [6][7][8][9] The pathology of LVH shows not only mechanical but also extensive cellular and molecular remodelling including cardiomyocyte growth changes, dysfunction of excitationcontraction coupling, certain metabolic dysfunctions, and fibrosis. 5 LVH is also associated with an increased prevalence of cardiac arrhythmias and constitutes an important risk factor for cardiac morbidity and mortality.…”

“…5 LVH is also associated with an increased prevalence of cardiac arrhythmias and constitutes an important risk factor for cardiac morbidity and mortality. [6][7][8][9] The pathology of LVH shows not only mechanical but also extensive cellular and molecular remodelling including cardiomyocyte growth changes, dysfunction of excitationcontraction coupling, certain metabolic dysfunctions, and fibrosis. 10,11 Patients with severe aortic stenosis-dependent symptoms have a tremendous risk of sudden cardiac death if only medically treated.…”