Heart Failure Hospitalizations Rise While the Number of Cases Drops

There are approximately 500,000 new cases of heart disease every year, and with heart failure being a potential complication in many of those cases, effective therapies are necessary.

Where are we with heart failure prevention and treatment? And what is on the horizon? That’s exactly what Clyde W. Yancy, MD, MSc, MACP, a cardiologist at Northwestern Memorial Hospital, addressed during a presentation at the 10^th Annual Cardiometabolic Health Congress (CMHC 2015) in Boston, Massachusetts.

“The instances of heart failure may be declining,” Yancy pointed out, presenting recently discovered data during the session. Hospitalizations due to heart failure have increased, however, by 34%. Notably, 63% of those cases were not caused by cardiovascular issues. Therefore, hospitalization is a driver in the epidemic of heart failure.

There are four stages of heart failure, according to the American Heart Association (AHA):

Stage A: No objective evidence of cardiovascular disease

Stage B: Objective evidence of minimal cardiovascular disease

Stage C: Objective evidence of moderate cardiovascular disease

Stage D: Objective evidence of severe cardiovascular disease

One study that Yancy referenced looked at hypertension as a risk factor for heart failure. By year 10 of hypertension, there was an overwhelming connection to heart failure In African Americans. Patients with high cardiovascular risk saw benefits with blood pressure-lowering treatment, but those with low cardiovascular risk did not. This suggests who should be targeted for aggressive treatment. Elevated heart rate can cause atherosclerosis which can lead to cardiovascular disease.

So what are medical professionals supposed to do about this? In a multiple randomized controlled trials, hydralazine/nitrate caused a risk reduction of 43%, beta blockers by 34%, aldosterone antagonist by 30%, and angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) by 17%,

Earlier this year, the US Food and Drug Administration (FDA) approved Ivabradine to reduce hospitalization from worsening heart failure. During the three-year SHIFT trial, the drug was linked to a 26% risk reduction in hospitalization for heart failure when combined with a beta-blocker. Ivabradine did not show benefit on mortality, however. Notably, the phase III study did not take place in the US, but the FDA accepted the data.

Ivabradine is currently being reviewed for future guidelines, Yancy revealed, who helps develop such protocols. “The future is promising, I’m only going to mention that we’re doing more studies with biomarkers,” Yancy concluded.