Delivering this year’s Kempson-Maddox lecture Professor David Kaye, Associate Director of Baker IDI Heart and Diabetes Institute, tells delegates five key things they should know about the ’emerging epidemic’ of heart failure with preserved ejection fraction.
Speaking to a packed hall here in Adelaide at the CSANZ’s 64th Annual Meeting Professor Kaye noted that over the last decade there had been a dramatic reduction in death from cardiovascular disease across all age spectrums – mainly as the result of advances such as newer interventional techniques, and medications. However, he said, things were a little different for heart failure.
“We haven’t seen the same degree of reduction in mortality or hospitalisations in HF…We have a long way to go both in the prevention and treatment of HF, particularly in older individuals,” he told delegates.
The lack of progress wasn’t down to the absence of good quality evidence. A myriad of trials over the past 30 years had contributed to building up a solid evidence base for diagnosing and managing heart failure.
“Things have evolved in interesting ways, both in the development of drugs but also in the way that we classify heart failure,” noted Professor Kaye who is also a cardiologist at The Alfred Hospital.
Years ago the diagnosis of heart failure was very much a clinical diagnosis but the SOLVD trial published in the NEJM in 1991 was when the idea of patient phenotyping really came to the fore.
The study was the first to introduce the concept of an LVEF <35% – as a means of ensuring homogeneity across studies.
Cardiologists were of course very familiar with classifying heart failure patients based on signs and symptoms (NYHA classification) and structure and symptoms (A to D), observed Professor Kaye.
However guidelines issued by the ESC this year on the diagnosis and treatment of heart failure had made things “even more complex” by introducing a ‘mid-range reduced ejection fraction’ in the 40 to 50 percent range.
“HFPEF – patients with an ejection fraction of over 50 percent – is really one of the emerging epidemics,” he said.
“It will become the major form of heart failure in the community partly related to ageing but also to other factors,” he told delegates.
Kaye’s five key things to know about HFPEF
- HFPEF is in the rise and accounts for up to 50% of the heart failure burden
- HFPEF can be difficult to assess /diagnose at rest – consider stress assessment by RHC or echo
- Prevention is probably the key – BP control, diet, obesity, interventions.
- In established HFPEF treat BP aggressively and careful volume control; and exercise training
- Carefully Investigate and manage co-morbidities e.g. AF, obesity and ischaemia.