Heart failure ‘less important than potholes ‘

Despite the substantial public health burden of heart failure it is deemed less important in public discourse than potholes, a study has found.
Compared to other serious health conditions such as cancer, heart failure seldom receives public recognition and is overlooked in terms of policy initiatives and funding, according to UK researchers.

A group from the National Institute for Health Research, London, analysed more than two billion words of 21st century English language text and parliamentary debates, to find that the term ‘heart failure’ was mentioned 4.26 times per million words while ‘cancer’ occurred 82 times per million words. While heart failure was almost 20 times less discussed than cancer in public, it also trailed behind mundane concerns such as ‘pot-holes’ which were mentioned over 10 times per million words.

“Results of this study should motivate all stakeholders involved in [heart failure] to redouble their efforts to spread awareness regarding the seriousness of the condition in general discourse as well as to engage parliamentarians better and thereby exert influence … to significantly improve investment in prevention, early diagnosis and better management of HF,” they wrote in Open Heart journal.

In Australia, the charity  is aiming to in increasing HF public awareness with launch of Australia’s first Heart Failure Awareness Week on 27 June – 3 July.

“The campaign creates an opportunity to encourage critical conversations about a disease that affects more than half a million Australians, and the importance of reform in heart failure diagnosis, treatment, and long-term management,” it says.

The group is also releasing a newly developed tool Recognising Heart Failure to assist GPs in the early diagnosis and management of heart failure, based on the Australian consensus of the recent ESC heart failure guidelines, available for download on the hearts4heart website.

“As healthcare providers, we play a critical role in encouraging people aged 65 and older to be aware of symptoms and get their hearts checked regularly. Be heart smart. Have regular conversations about heart health with your patients, talk about possible symptoms, and be sure you understand the appropriate diagnostic pathway,” said cardiologist Associate Professor John Amarena of Geelong, Victoria.

Poor Australians miss out on cardioprotective diabetes drugs

Use of newer cardioprotective glucose-lowering drugs such as SGLT-2 inhibitors and GLP-1 receptor agonists has increased in Australia in recent years but there is a substantial socioeconomic gap in uptake and usage.

A review of PBS data for more than a million people with type 2 diabetes found that by 2019, 21% were receiving a SGLT2 i and 6% were receiving a GLP-1 RA.

There were disparities in receipt of cardioprotective agents by socioeconomic status, with people in more disadvantaged areas less likely to receive  an SGLT2i (Hazard Ratio compared to least disadvantaged area 0.90, or receive a GLP-1 RA (HR 0.81).

People in more disadvantaged areas were also less likely to persist with cardioprotective agent, they study from the Baker Heart and Diabetes Institute, Melbourne, found.

The study authors also noted that DPP4 inhibitors were still the most common second-line glucose lowering drug in 2019.

“Expanding the PBS criteria for GLP-1 RAs and SGLT2is in a manner that recognises their effects beyond glycaemia may be warranted to increase use among individuals who stand to benefit  from their cardio- and  reno-protective effects,” they wrote in Diabetic Medicine.

New clue to cardiac hypertrophy pathway

A research team at the Victor Chang Cardiac Research Institute say they have discovered a major molecular clue to the development of heart muscle wall thickening in cardiac hypertrophy.

Dr Jane Yu and Dr Boris Martinac have published a paper in Nature Cardiovascular Research that identifies Piezo1 as the cardiomyocyte mechanosensor that instigates the maladaptive hypertrophic response to pressure overload.

The team’s work has also highlighted the a role for coupling with TRPM4 to activate the hypertrophic signalling pathway.

The finding provides a potential therapeutic target not just for cardiac hypertrophy but also for heart attack and stroke, they believe

“We hope that in the long-term, as soon as we see evidence of heart muscle thickening you will be given a treatment, perhaps a small peptide, that will stop the process from progressing in your heart. This could even potentially be given to people with severe hypertension to avoid them developing cardiac hypertrophy in the first place,” said Dr Yu.

“This preventative treatment could make a huge inroad into reducing the number of people affected by heart disease in Australia and save many lives in the future.”