The Total Number of Americans Living With Heart Failure is Projected to Increase 46% From ~5.8 Million in 2012 to ~8.5 Million In 2030

TAKE A

CLOSER LOOK

PATIENTS WHO HAVE HAD A

WORSENING HF EVENT
ARE AT INCREASED RISK FOR FUTURE EVENTS1

PATIENTS WHO HAVE HAD A WORSENING HF EVENT ARE AT INCREASED RISK FOR FUTURE EVENTS

TAKE A CLOSER LOOK PATIENTS WHO HAVE HAD A
WORSENING HF EVENT ARE AT INCREASED RISK FOR FUTURE EVENTS1

The total number of Americans living with heart failure is projected to increase 46% from ~5.8 million   in 2012 to ~8.5 million in 20302

WHAT DO WORSENING HF EVENTS LOOK LIKE?

HF = heart failure

A worsening HF event is characterized by an episode of worsening symptoms, despite a period of stabilization on recommended therapy1,3

 

An observational cohort study  identified 11,064 adult patients   newly diagnosed with HFrEF  (LVEF ≤45%) between January 2011   and December 2014 using the NCDR  PINNACLE registry. Among these  patients, 1,851 experienced a  worsening HF event1

HFrEF = heart failure with reduced ejection fraction; LVEF = left ventricular ejection fraction; NCDR = National Cardiovascular Data Registry

In this study, ~1 in 6 patients with HFrEF experienced a worsening HF event on average 18 months after initial diagnosis of HF (n=1,851)1

In this study, ~1 in 6 patients with HFrEF experienced a worsening HF event on average 18 months after initial diagnosis of HF (n=1,851)1

In the same study, in the subset of  patients with HFrEF who experienced  a worsening HF event (n=1,851),

WORSENING  HF EVENTS  INCREASED THE RISK  OF HF-RELATED  HOSPITALIZATION  OR DEATH…1 

In the same study, in the subset of  patients with HFrEF who experienced  a worsening HF event (n=1,851),

~56%WERE REHOSPITALIZED  WITHIN 30 DAYS  OF THE WORSENING HF EVENT 1 

In the same study, in the subset of  patients with HFrEF who experienced  a worsening HF event (n=1,851),

>1IN5   DIED WITHIN  2 YEARS OF THE  WORSENING HF EVENT 1 

Take a closer look at  worsening chronic HF

An Observational Cohort Study Identified 11,064 Adult Patients Newly Diagnosed With HFrEF (LVEF ≤45%) Between January 2011 and December 2014 Using the NCDR PINNACLE Registry. Among These Patients, 1,851 Experienced a Worsening HF Event
In an Observational Cohort Study, ~1 in 6 Patients With HFrEF Experienced a Worsening HF Event On Average 18 Months After Initial Diagnosis of HF
There are Many Pathways Involved in Worsening Chronic HF

THERE ARE MANY

PATHWAYS INVOLVED IN

WORSENING CHRONIC HF

THERE ARE MANY

PATHWAYS INVOLVED

IN WORSENING CHRONIC HF

Pathways Involved in Worsening Heart Failure Include; SNS/HR, RAAS, NPS, and NO-sGC-cGMP

SNS/HR4-6

Activation of the SNS results in:

Increased cardiac contractility

Activation of the RAAS

Increased heart rate through  stimulation of funny (f) channel  activity in the sinoatrial node 

HR = heart rate; RAAS = renin-angiotensin-aldosterone system; SNS = sympathetic nervous system

RAAS4,5

Overactivation of  the RAAS results in:

Increased production of renin,  angiotensin II, and aldosterone,  and decreased renal blood flow

Increased sodium resorption  and water retention

Pathways Involved in Worsening Chronic Heart Failure Include: SNS/HR, RAAS, NPS, and NO-sGC-cGMP

NPS4

Increased peripheral resistance  to the NPS contributes to  further vasoconstriction and  water retention

The NPS would normally  counteract the activity of the  SNS and the RAAS

NPS = natriuretic peptide system

NO-sGC-cGMP7

Reduced sGC-cGMP activity, which results from reduced  NO bioavailability, may lead to ventricular remodeling as well as vascular and myocardial dysfunction

NO-sGC-cGMP = nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate

NPS4

Increased peripheral resistance  to the NPS contributes to   further vasoconstriction and   water retention

The NPS would normally   counteract the activity of the   SNS and the RAAS

NPS = natriuretic peptide system

NO-sGC-cGMP7

Reduced sGC-cGMP activity, which results from reduced NO bioavailability, may lead to ventricular remodeling as well as vascular and myocardial dysfunction

NO-sGC-cGMP = nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate

Together, these pathways may contribute to  worsening chronic HF pathophysiology4-7

Take a closer look at the pathways involved  in worsening chronic HF

 

References

1. Butler J, Yang M, Manzi MA, et al. Clinical course of patients with worsening heart failure with reduced ejection fraction.  J Am Coll Cardiol. 2019;73(8):935-944. 2. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606-619. 3. Greene SJ, Mentz RJ, Felker GM. Outpatient worsening heart failure as a target for therapy: a review. JAMA Cardiol. 2018;3(3):252-259.   4. Buglioni A, Burnett JC Jr. Pathophysiology and the cardiorenal connection in heart failure. Circulating hormones: biomarkers or mediators. Clin Chim Acta. 2015;443:3-8. 5. Jackson G, Gibbs CR, Davies MK, Lip GY. ABC of heart failure. Pathophysiology. BMJ. 2000;320(7228):167-170.  6. DiFrancesco D. The role of the funny current in pacemaker activity. Circ Res. 2010;106(3):434-446.  7. Gheorghiade M, Marti CN, Sabbah HN, et al. Soluble guanylate cyclase: a potential therapeutic target for heart failure. Heart Fail Rev. 2013;18(2):123-134.