This week we continue to look at the biggest challenges facing cardiology in 2018, shining the spotlight on heart failure.

There will be a “continued explosion” in the number of patients with heart failure this year which will stretch health resources, predicts Professor Andrew Sindone, director of the heart failure unit and the department of cardiac rehabilitation at Concord Hospital in Sydney.

He also expects to see an increasing proportion of patients will have heart failure with preserved ejection fraction “for which there is little evidence of benefit for most therapies”, and this will  “continue to be a source of frustration”.

Heart failure affects 2% of the population and each year is associated with 61,000 deaths, 1.1 million days of hospital stays and  $3.1 billion in health costs.

The patient profile is likely to change, with people presenting older, more unwell and with multiple co-morbidities.

Meanwhile the focus of care will shift from reduction in length of stay to reductions in 30 day readmissions which will continue to be a major challenge, he predicts.

New data regarding angiotensin receptor neprolysin inhibitors (ARNIs) in heart failure with preserved ejection fraction, SGLT2 inhibitors in patients with heart failure and novel agents currently under investigation hold some hope for the future, he says.

“The great sources of optimism stem from increased use of guideline-based medications, such as ACE inhibitors/ARBs, beta blockers and aldosterone antagonists, as well as increased uptake of medications which lead to further improvements in outcomes in patients with heart failure such as angiotensin receptor neprolysin inhibitors (ARNIs), sinus node inhibitors and SGLT2 inhibitors in appropriate patients.”

However on the whole, we are in for a challenging road ahead.

“Heart failure will continue to grow as a major cause of morbidity and mortality over the course of the year,” Professor Sindone concludes.