Heart failure in the general population and impact of the 2021 European Society of Cardiology Heart Failure Guidelines

TY - JOUR

T1 - Heart failure in the general population and impact of the 2021 European Society of Cardiology Heart Failure Guidelines

AU - Wenzel, Jan-Per

AU - Nikorowitsch, Julius

AU - Bei der Kellen, Ramona

AU - Magnussen, Christina

AU - Bonin-Schnabel, Renate

AU - Westermann, Dirk

AU - Twerenbold, Raphael

AU - Kirchhof, Paulus

AU - Blankenberg, Stefan

AU - Schrage, Benedikt

N1 - © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PY - 2022/8

Y1 - 2022/8

N2 - AIM: The diagnosis of heart failure (HF) has been refined in several steps in recent years, reflecting evolving diagnostic and therapeutic approaches. The European Society of Cardiology (ESC) recently published a modified definition of HF in the 2021 heart failure (HF) guidelines. The impact of this new diagnostic algorithm on the prevalence of HF is not known. The aim of this study was to describe the contemporary prevalence of HF in a representative, completely phenotyped sample from the general population.METHODS AND RESULTS: This analysis was conducted among 7074 participants (aged 45-78 years, 51.5% women) from the population-based Hamburg City Health Study. Compared with the 2016 version, HF prevalence increased with the 2021 HF guidelines from 4.31% to 4.83% (12% increase). This increase was driven by a higher number of subjects with HF with reduced/mildly-reduced ejection fraction (0.47% to 0.52%; 1.37% to 2.12%), while the number of subjects with HF with preserved ejection fraction decreased from 2.46% to 2.19%. Importantly, this did not impact the known risk factor profiles of the phenotypes. Although four drugs are recommended for all subjects with HFrEF in the new guidelines, several adjunctive therapies are recommended for dedicated cases/scenarios (e.g. <1% eligibility for ivabradine/vericiguat/devices).CONCLUSION: Heart failure remains common in a contemporary general population sample. The number of patients with HF will increase when the current diagnostic criteria are applied. This offers opportunities to initiate preventive therapies, especially in patients with HFmrEF and HFrEF.

AB - AIM: The diagnosis of heart failure (HF) has been refined in several steps in recent years, reflecting evolving diagnostic and therapeutic approaches. The European Society of Cardiology (ESC) recently published a modified definition of HF in the 2021 heart failure (HF) guidelines. The impact of this new diagnostic algorithm on the prevalence of HF is not known. The aim of this study was to describe the contemporary prevalence of HF in a representative, completely phenotyped sample from the general population.METHODS AND RESULTS: This analysis was conducted among 7074 participants (aged 45-78 years, 51.5% women) from the population-based Hamburg City Health Study. Compared with the 2016 version, HF prevalence increased with the 2021 HF guidelines from 4.31% to 4.83% (12% increase). This increase was driven by a higher number of subjects with HF with reduced/mildly-reduced ejection fraction (0.47% to 0.52%; 1.37% to 2.12%), while the number of subjects with HF with preserved ejection fraction decreased from 2.46% to 2.19%. Importantly, this did not impact the known risk factor profiles of the phenotypes. Although four drugs are recommended for all subjects with HFrEF in the new guidelines, several adjunctive therapies are recommended for dedicated cases/scenarios (e.g. <1% eligibility for ivabradine/vericiguat/devices).CONCLUSION: Heart failure remains common in a contemporary general population sample. The number of patients with HF will increase when the current diagnostic criteria are applied. This offers opportunities to initiate preventive therapies, especially in patients with HFmrEF and HFrEF.

KW - Cardiology

KW - Female

KW - Heart Failure/diagnosis

KW - Humans

KW - Male

KW - Prognosis

KW - Stroke Volume

KW - Ventricular Function, Left

U2 - 10.1002/ehf2.13948

DO - 10.1002/ehf2.13948

M3 - SCORING: Journal article

C2 - 35445582

VL - 9

SP - 2157

EP - 2169

JO - ESC HEART FAIL

JF - ESC HEART FAIL

SN - 2055-5822

IS - 4

ER -