Heart failure
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Understanding Heart Failure: Epidemiology, Pathophysiology, and Treatment Advances
Epidemiology of Heart Failure
Prevalence and Demographics
Heart failure (HF) is a significant global health issue, affecting over 37.7 million individuals worldwide5. The prevalence of HF is increasing due to the aging population and improved survival rates from acute cardiovascular events3. Notably, HF is the leading cause of hospitalization among individuals over 65 years old1 6. The incidence of HF has stabilized in some populations but is rising among younger individuals, likely due to increasing obesity rates2.
Global Trends and Socioeconomic Impact
The burden of HF is not uniform across the globe. In low-income countries, the prevalence of HF is rising due to the double burden of communicable diseases and lifestyle-related conditions2. In the USA, the economic impact of HF is substantial, with medical costs projected to rise from $20.9 billion in 2012 to $53.1 billion by 20305.
Pathophysiology of Heart Failure
Mechanisms and Compensatory Responses
Heart failure occurs when the heart cannot pump sufficient blood to meet the body's needs, leading to symptoms such as dyspnea, fatigue, and fluid retention9. The heart attempts to compensate through mechanisms like ventricular dilation, hypertrophy, and increased heart rate1 9. However, these compensatory mechanisms eventually exacerbate the condition, creating a vicious cycle of worsening HF9.
Metabolic Remodeling
Metabolic remodeling is a critical aspect of HF, characterized by defects in energy production and changes in metabolic pathways8. Advances in omics technologies have provided deeper insights into these metabolic changes, including the utilization of alternative substrates like ketone bodies and branched-chain amino acids in end-stage HF8.
Classification and Stages of Heart Failure
Universal Definition and Stages
A universal definition of HF includes symptoms caused by structural or functional cardiac abnormalities, corroborated by elevated natriuretic peptide levels or evidence of congestion4. HF is classified into stages: At-risk (Stage A), Pre-heart failure (Stage B), HF (Stage C), and Advanced HF (Stage D)4. Additionally, HF is categorized based on left ventricular ejection fraction (LVEF) into HF with reduced EF (HFrEF), mid-range EF (HFmrEF), preserved EF (HFpEF), and improved EF (HFimpEF)4.
Treatment Advances in Heart Failure
Pharmacological Therapies
Several pharmacological treatments have proven effective for HF with reduced ejection fraction (HFrEF), including ACE inhibitors, ARBs, β-blockers, and mineralocorticoid receptor antagonists3. The introduction of angiotensin receptor-neprilysin inhibitors (ARNIs) has shown improvements in hospital admissions and mortality compared to traditional therapies3. Antidiabetic therapies are also being explored for their potential benefits in HF patients3.
Device and Surgical Interventions
Advanced device therapies, such as left ventricular assist devices (LVADs) and biventricular pacemakers, are becoming more common for patients with severe symptoms1 3. These devices help improve cardiac function and patient outcomes. Surgical options, including heart transplantation and ventricular resynchronization therapy, are considered for advanced HF cases9.
Challenges and Future Directions
Unmet Needs and Research Gaps
Despite significant advancements, HF with preserved ejection fraction (HFpEF) remains a challenging and heterogeneous disorder with no conclusive therapy3. Future research is needed to develop effective treatments for HFpEF and to address the complex interplay of physiological, psychological, and situational factors contributing to HF-related fatigue7.
Innovative Approaches
New drugs with novel mechanisms, such as cardiac myosin activators, are under investigation for their potential to improve outcomes in HF patients3. Additionally, comprehensive characterization of predictors of readmission and the development of patient-centered care models are essential to reduce hospitalizations and improve quality of life for HF patients6.
Conclusion
Heart failure remains a major public health challenge with significant morbidity, mortality, and economic impact. While advancements in pharmacological and device therapies have improved outcomes for many patients, ongoing research and innovative approaches are crucial to address the unmet needs, particularly for HFpEF. Understanding the evolving epidemiology, pathophysiology, and treatment landscape of HF is essential for developing effective strategies to combat this pervasive condition.
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Most relevant research papers on this topic
Heart Failure
Biventricular pacemakers show promise in treating heart failure by improving blood flow and reducing heart muscle damage.
Highly CitedEpidemiology of heart failure
Heart failure incidence has stabilized in some populations, but is increasing in young people due to obesity and a shift towards heart failure with a preserved ejection fraction, suggesting we have not yet reached the end of the epidemic.
Highly CitedHeart failure
Heart failure treatments have improved outcomes for patients with reduced ejection fraction, but new therapies are needed for heart failure with preserved ejection fraction and acute heart failure.
Rigorous JournalHighly CitedUniversal Definition and Classification of Heart Failure.
A universal definition of heart failure, with revised stages and classification based on left ventricular ejection fraction, is proposed.
Highly CitedEpidemiology and aetiology of heart failure
Heart failure is a rapidly growing public health issue with a majority of cases being preventable, causing increased morbidity and mortality, and posing a substantial burden to the health-care system.
Highly CitedEpidemiology of Heart Failure
Heart failure is an epidemic with high mortality, morbidity, and healthcare expenditures, and new patient-centered care models are needed to decrease hospitalizations and improve outcomes for patients with complex coexisting conditions.
Rigorous JournalHighly CitedFatigue in Heart Failure
Heart failure-related fatigue is influenced by physiologic, psychologic, and situational factors, which should be addressed in developing treatment modalities.
Systematic ReviewMetabolic remodeling of substrate utilization during heart failure progression
Metabolic remodeling during heart failure progression involves defects in energy production and changes in metabolic pathways, with new developments in multi-omics studies providing a clearer understanding of these changes.
Systematic ReviewThe pathophysiology of heart failure.
Heart failure occurs when the heart cannot provide sufficient blood flow to meet metabolic requirements or accommodate systemic venous return, leading to symptoms and a 50% 5-year mortality rate.
Highly CitedTackling heart failure in the twenty-first century
New treatments targeting disease mechanisms at the cellular and whole-organ level are needed to halt and reverse the devastating consequences of heart failure in the 21st century.
Highly Cited