Burden of Heart Failure and Future Trends

Transcript: Deepak L. Bhatt, MD, MPH: Let’s move on now to discuss an overview of heart failure, and its clinical burden. Javed, what are your thoughts about the different types of heart failure? What’s the most common type? What are the clinical and economic burdens of heart failure, as well as the different trends in heart failure? That’s a lot of information, but maybe we can start off with you?

Javed Butler, MD, MPH, MBA: I think it’s a big enough problem right now, and then if you look at the projections, it’s only going to get worse unless we do something really dramatic in terms of preventing heart failure. When we look at different estimates, approximately 5.56 million Americans have heart failure, and 750,000 to 1 million new cases are diagnosed on an annual basis. The projection is approximately a 25% increase in prevalence by 2030. Part of the problem is the older population—of course, there’s a tight relationship between age and risk for heart failure. But high blood pressure, diabetes, and obesity—all these risk factors are actually a bit more prevalent in the population now than in the past. So when you consider all these things, the problem is projected to increase. Our success also plays a role because now we can take better care of patients with valve disease and with ischemic heart disease. Patients who may not have survived some acute event—they now live.

How to divide patients with heart failure is an unbelievably interesting and intensely debated topic. Generally speaking, the way we have thought about heart failure is to divide it based on ejection fraction—so patients with heart failure with preserved or normal ejection fraction, and patients with heart failure with reduced ejection fraction. Traditionally, we have just sort of said it’s evenly split, with both at 50%. But some data have actually come out that suggest that at least for the hospitalized heart failure patients, the trend is increasing for heart failure with preserved ejection fraction. So rather than 50% and 50%, it may be more like 55% or 58% versus 42%, 45%. And that trend is sort of consistent with the older population as well.

Whether or not to think about patients who get hospitalized with heart failure as a different entity—again one can argue whether that’s true or not. But they’re certainly a separate group of patients in terms of their risk for adverse outcomes and of the therapies that they need and deserve.

Then, the cost of heart failure. Even if you look at the direct cost of heart failure, we are talking about $30 billion plus. The indirect costs are obviously much more than that. Along with the increased prevalence of heart failure, the costs are expected to increase to about $70 billion annually by 2030. A portion of that is related to hospitalization costs, because these patients are at particularly high risk of getting repeatedly hospitalized.

Deepak L. Bhatt, MD, MPH: Those were really terrific insights for our audience.

Transcript Edited for Clarity