Optimizing outcomes in heart failure: 2022 and beyond

Abstract

Although the development of therapies and tools for the improved management of heart failure (HF) continues apace, day‐to‐day management in clinical practice is often far from ideal. A Cardiovascular Round Table workshop was convened by the European Society of Cardiology (ESC) to identify barriers to the optimal implementation of therapies and guidelines and to consider mitigation strategies to improve patient outcomes in the future. Key challenges identified included the complexity of HF itself and its treatment, financial constraints and the perception of HF treatments as costly, failure to meet the needs of patients, suboptimal outpatient management, and the fragmented nature of healthcare systems. It was discussed that ongoing initiatives may help to address some of these barriers, such as changes incorporated into the 2021 ESC HF guideline, ESC Heart Failure Association quality indicators, quality improvement registries (e.g. EuroHeart), new ESC guidelines for patients, and the universal definition of HF. Additional priority action points discussed to promote further improvements included revised definitions of HF ‘phenotypes’ based on trial data, the development of implementation strategies, improved affordability, greater regulator/payer involvement, increased patient education, further development of patient‐reported outcomes, better incorporation of guidelines into primary care systems, and targeted education for primary care practitioners. Finally, it was concluded that overarching changes are needed to improve current HF care models, such as the development of a standardized pathway, with a common adaptable digital backbone, decision‐making support, and data integration, to ensure that the model ‘learns’ as the management of HF continues to evolve.

The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction

“…Those who refused the opportunity for FUP at our HF Outpatient Clinic are referred to as "non-HFOC patients". For HFOC patients, a structured, patient-centred and individualised follow-up was initiated in which patient management was led by a cardiologist specialising in HF, working in close collaboration with HF nurses [13,25,30] and other cardiology subspecialties and specialists of other comorbidities. For those participating in the HFOC at our centre, the schedule of outpatient visits was individualised (in general, in-office controls were undertaken every 3 months, with variable but more frequent in-office and remote controls for those with treatment optimisation in the post-discharge phase and those with more advanced stages of the disease).…”

“…A total of 40% of patients required hospitalisation for HF before the index event, 32% were newly diagnosed (de novo) HFrEF patients and 45% had at least partly ischaemic aetiology of HF. Median LVEF was 25 [20][21][22][23][24][25][26][27][28][29][30]%. Diabetes mellitus affected 40% of the population, while hypertension affected 62% and atrial fibrillation/flutter 46%.…”

“…As the prevalence of HF continues to rise due to the ageing population, better diagnostic tools and improved therapeutic options [4], there is a growing need for a dedicated, specialised HFOC network. Although in 2011 the ESC Heart Failure Association [6] and in 2008 the Heart Failure Society of America [24] also published documents focusing on the key elements of HF care, HFOC does not have a broadly accepted standardised protocol [25]. It is generally accepted that its main elements involve educating, monitoring, clinically following and supporting the patient with an emphasis on self-care, regularly considering therapy optimisation possibilities and adopting a multidisciplinary, holistic approach that focuses on managing the growing number of comorbidities [5,8,[25][26][27].…”

The redox-active defensive Selenoprotein T as a novel stress sensor protein playing a key role in the pathophysiology of heart failure

“…Even if hypertension and hypertension-induced hypertrophy are among the most recognized risk factors, it is currently admitted that HF consists of multifactorial and complex changes in cardiovascular physiology [ 1 , 2 ]. Thus, despite the arsenal of therapies proposed, the affected population increases year by year and the management in clinical practice is even more complicated [ 3 ]. Indeed, expenses related to HF are a burden for healthcare systems worldwide since high hospitalization rates, secondary to the associated morbidity and mortality, are recorded [ 4 ].…”