Heart failure is by far the single biggest reason for acute hospital admission. Around 30 million people in Europe have heart failure and its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack but with damage to the heart muscle.
According to one study, the reported prevalence among those aged 65-74 years is one in 35, and among the over-85s one in seven.
* Professor Jeroen Bax, European Society of Cardiology Congress Programme Committee Chair 2006-2008, has spoken of "an exponential growth in patients presenting heart failure".
* The American Heart Association recently described the prevention of heart failure as "an urgent public health need".
Despite the increasing prevalence and the urgency, there are huge challenges in the prevention, diagnosis and treatment of heart failure. These will all be addressed at Heart Failure 2008 Congress, this year's annual meeting of the Heart Failure Association of the European Society of Cardiology, which takes place in Milan from 14-17 June.
According to Professor Kenneth Dickstein, President of the Heart Failure Association of the ESC, heart failure comprises "an enormous population, but we have a hard time identifying that population". It's the mission of Heart Failure 2008 Congress to improve awareness of the condition, improve its diagnosis in primary care, and thereby improve the quality of life for those affected and reduce hospital admissions.
1. A simpler definition
Heart failure is a cluster of symptoms resulting from the heart's inability to pump blood as required by the body. This in itself is usually because of previous damage to the heart muscle, following a heart attack, coronary disease or hypertension. The resulting symptoms of heart failure are breathlessness, exercise intolerance, and a build-up of fluid in the lungs and abdomen. Traditional definitions of heart failure have made a distinction between "acute" and "chronic" conditions; new European guidelines on heart failure to be published later this year by the ESC- and previewed at this congress - will simplify the definition and remove any confusing distinction between acute and chronic.
2. There is still much to learn
The new European guidelines identify more than 30 areas in the management of heart failure where there is little good clinical trial evidence on which to base practice. "The central issues still need addressing," says Professor Dickstein. "The fact is that heart failure responds to treatment, and research is moving very quickly, but it takes time for new treatments to become established." Late-breaking news sessions at this congress will provide clinical trial updates on new devices and two new drugs, one designed to improve the heart's systolic function, and another its diastolic performance.
3. "Prevention is everything, but . . .”
While "prevention is everything", says Professor Dickstein, Heart Failure 2008 Congress will focus on managing real patients with established symptoms. It is Dickstein's view that heart failure is part of the diagnosis in more than 50% of patients admitted to hospital. "And in the community," he adds, "people just don't realise they have a treatable disease. Breathlessness, tiredness, bronchitis . . . They simply accept these symptoms as part of ageing. It's one purpose of this congress to help primary care physicians identify the undiagnosed people with heart failure." Around 70% of heart failure patients are today managed by primary care physicians. "They need to know what treatment options are available," says Dickstein.
4. The changing face of heart failure
The opening session of Heart Failure 2008 Congress will present heart failure as a burgeoning public health issue, whose impact has gathered momentum as a result of an ever ageing society and a continuing prevalence of coronary heart disease as a major cause of "cardiac suction failure". Interventions likely to improve prognosis and the subject of debate are measures aimed at reducing heart rate (described by the ESC's President-Elect Professor Roberto Ferrari from Italy) and improving renal function, the use of neurohormonal antagonists (described by the editor of the European Journal of Heart Failure Professor Karl Swedberg from Sweden), and the application of devices and remote monitoring to improve myocardial performance (described by the editor of the European Journal of Cardiovascular Nursing Tiny Jaarsma from the Netherlands).
Professor Michel Komadja, France, Vice-President of the ESC's Working Groups, Councils, will propose that the clinical profile of heart failure patients has dramatically changed over the past decades. "Today," he says, "the average age of patients hospitalised for heart failure is over 70. All surveys suggest that management of this group of patients is not optimal. Elderly heart failure patients do not receive the quality of care recommended by international guidelines both for investigations and treatment."