How have HF mortality rates changed from 1999-2021 in the US?

From 1999-2012
↘ : Decline by ~25%

From 2012-2021
↗ Reversals that have now undone ALL initial declines.

🚨HF mortality in 2021 > HF mortality in 1999 🚨

jamanetwork.com/journals/jamac…

Marat Fudim, MD MHS Ahmed Sayed HFSA

Analysis shows that initial declines in HF-related mortality from 1999 to 2012 have been entirely undone by subsequent reversals from 2012 to 2021, meaning that contemporary HF mortality rates are higher than in 1999. ja.ma/3UcwM23

HFrEF ↘️↘️↘️median survival 7-18 years

GDMT ↗️↗️↗️ median survival:

✅ ARNI 2-3 yrs (1-2 yrs vs ACEI or ARB)
✅ BB 3-4 yrs
✅ MRA 2-3 yrs
✅ SGLTi 1-2 yrs

Clinical benefits non-overlapping, incremental, additive

Quadruple >>>triple>>>double

Fast >>>>slow

Now>>>later

Decline in heart failure deaths has been undone, led by people under 45 statnews.com/2024/04/24/hea… via STAT

JAMA Cardiology Clyde Yancy, MD, MSc Marat Fudim, MD MHS Javed Butler Ahmed Sayed

What now❓

⏫ Interventions to prevent HF

⏫ Interventions to treat HF

⏫ Wider & equitable access (potential role for remote patient care?)

❓ Revisit potentially problematic policies

🔬 Revisit impact of pandemic on healthcare

How have HF mortality rates changed from 1999-2021 in the US❓

From 1999-2012📉: Decline by ~25%
From 2012-2021📈: Reversals that have now undone ALL initial declines.

Result: HF mortality in 2021 > HF mortality in 1999 ‼️

Link to our work JAMA Cardiology : jamanetwork.com/journals/jamac…

Why❓

Potential culprits:

1⃣ ⏫ metabolic disease ➡️ ⏫ HF prevalence

2⃣ 🚫care access ➡️ 🚫GDMT ➡️ ⏫ HF mortality

3⃣ HRRP ➡️ bad incentives ➡️ ⏫ HF mortality

4⃣COVID (exacerbating) ➡️ healthcare interruptions +/- 🫀involvement ➡️ ⏫ HF prevalence/mortality

Effects of #GDMT across Kidney Function Spectrum

✅ #BB : consistent benefit to eGFR 30
✅ #ARNI : consistent benefit to eGFR 30
✅ #SGLT2i : consistent benefit to eGFR 20
❌ #SteroidalMRA : ↓ benefit & worse safety at lower eGFR

New strategies to block MR axis in HF & CKD needed!

Impressive data on HFrEF: Although 82% of patients are eligible for quadruple therapy at discharge, only 15% actually receive it. This underutilization could significantly impact patient outcomes.

Gregg Fonarow MD JACC Journals American College of Cardiology Circulation European Society of Cardiology News

jacc.org/doi/10.1016/j.…

⚠️Eligibility and Projected Benefits of Rapid Initiation of Quadruple Medical 💊
for Newly Diagnosed #HF

👥 33036 🇺🇸newly diagnosed with HFrEF
👉82% were eligible for4️⃣💊,
👉93% were eligible for 3️⃣💊

⏰ 2021- 2023, of 👥 eligible for 4️⃣💊
▶️15.3% were prescribed 4️⃣💊
▶️41.5%…

We have to shift the acute care mindset beyond 'diurese & discharge' with ADHF. #GDMT saves lives and we must strive to get patients on quadruple therapy while hospitalized

Bailey Ann Estes Viet Le DMSc PA-C FACC FAHA HF-Cert Andrea Price, RCIS, CPHQ, AACC Derek Pineda Gregg Fonarow MD Steve Greene

Great work by our team UCLA Health on using #AI Machine Learning approach to predict mortality in admitted heart failure patients. Gregg Fonarow MD Pratyaksh Srivastava, MD
European Society of Cardiology Journals
onlinelibrary.wiley.com/doi/10.1002/eh…

Machine learning models built from commonly recorded patient information can accurately predict in-hospital mortality among patients hospitalized with HF

- Jawadi - ESC Heart Failure onlinelibrary.wiley.com/doi/10.1002/eh…

Ali Nsair, MD Pratyaksh Srivastava, MD UCLA Cardiology Fellowship European Society of Cardiology Journals

🟢Effects of sacubitril/valsartan according to polypharmacy status in PARAGON-HF

👉 post hoc analysis, baseline 💊 status was available in 4793 of 4796👥
💡 effects of SV🆚valsartan, were assessed according to the number of medications at baseline

🎯 primary outcome was total…

Interdisciplinary heart failure clinics are effective for GDMT titration, but multifactorial interventions may be necessary for further optimization and initiation of GDMT

Interventions for Optimization of Guideline-Directed Medical Therapy jamanetwork.com/journals/jamac…

JAMA Cardiology