The problem of the heart
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The Problem of Heart Failure: An Overview
Heart Failure Epidemiology and Public Health Impact
Heart failure (HF) is a significant and growing public health issue, affecting millions globally. It was designated as an emerging epidemic in 1997 and continues to be a major clinical and public health problem . The prevalence of HF is particularly high among individuals aged 65 and older, contributing to substantial healthcare expenditures. Despite advances in treatment, the burden of mortality and hospitalization due to HF remains high .
Changing Case Mix and Persistent Challenges
The case mix of HF has evolved over time, with an increasing proportion of patients presenting with preserved ejection fraction (HFpEF), for which effective treatments are still lacking . This shift complicates the management of HF, as traditional therapies are less effective for HFpEF compared to heart failure with reduced ejection fraction (HFrEF). Additionally, disparities in HF occurrence, presentation, and outcomes persist, particularly among younger Black men and women.
Multimorbidity and Aging Population
The aging population and the presence of multimorbidity further complicate HF management. Many HF patients suffer from multiple coexisting conditions, which necessitates a comprehensive approach to care . The interplay of various physiological and metabolic pathways in chronic heart failure (CHF) highlights the need for multidisciplinary management strategies.
Hospitalizations and Readmissions
Hospitalizations for HF remain frequent and costly, despite efforts to reduce them through preventive measures . The rates of readmissions continue to rise, underscoring the need for better predictors of readmission and more effective community-based support systems for HF patients.
Advances in Understanding and Treatment
Recent advances in understanding the molecular and genetic basis of heart diseases have opened new avenues for treatment. For instance, the study of ion channels and genetic information has provided insights into conditions like cardiomyopathy and has shown promise in cardiac gene therapy trials. However, despite these advances, HF remains incurable, and patients often have a poor prognosis.
Emerging Risk Factors and Holistic Management
Emerging risk factors, including those identified through omics sciences, offer the potential to discover new mechanistic pathways leading to HF. A holistic management approach that recognizes HF as a syndemic—interacting with multimorbidity, aging, and social determinants of health—is essential for addressing the persisting burden of HF.
Conclusion
Heart failure continues to be a complex and multifaceted public health problem. While the incidence of HF may be stabilizing or declining, the burden of mortality, hospitalization, and readmission remains significant. The evolving case mix, particularly the rise in HFpEF, and the challenges posed by multimorbidity and an aging population, necessitate a comprehensive and multidisciplinary approach to HF management. Advances in molecular and genetic research hold promise for future therapies, but the need for effective treatments and holistic management strategies remains critical.
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