Putting more emphasis on prevention in heart failure care
Heart failure is often treated after a patient starts becoming very ill, rather than as a preventable condition. This prompted a recent joint scientific statement from the Heart Failure Society of America (HFSA) and the American Society for Preventive Cardiology (ASPC) squarely aimed at shifting away from a largely reactive model and instead moving to prevention of advanced disease when patients are much easier to manage.[1]
The statement, co-chaired by Martha Gulati, MD, MS, FACC, FAHA, FASPC, FESC, director of prevention, associate director, Barbra Streisand Women's Heart Center, Cedars-Sinai, and past president of the ASPC, underscores the growing toll of the growing heart failure epidemic on patients and the U.S. healthcare system. More than 6 million Americans are currently living with the condition, with costs exceeding $30 billion annually.
“We need to be focused a lot more on prevention of heart failure, not just at the time when patients are diagnosed,” Gulati said. “There are things we can do to identify people earlier and intervene. In pre-heart failure, there are lots of therapies that we can initiate so that they never progress into the more symptomatic versions or advanced versions of heart failure.
The statement highlights a framework that spans the continuum of care, beginning with Life’s Essential 8, the American Heart Association’s foundation for cardiovascular health, which includes healthy diet, regular physical activity and tobacco avoidance. It also emphasizes the potential of risk scoring tools, biomarkers, genetic screening and cardiac rehabilitation to identify and treat patients in the earliest stages of disease.
The central figure from the statement offers a staging system for pinpointing a patient's heart failure status and, accordingly, recommending present and future interventions.
"The sad side is the people who need to actually be getting therapies that could be lifesaving," Gulati explained. "That could reduce hospitalization and potentially prevent heart failure. We are hoping our entire medical community, and the cardiology community specifically, starts being early proactive rather than reactive."
Gulati also pointed to the newly updated PREVENT risk score, which expands beyond atherosclerotic cardiovascular disease to also include heart failure, as an important step forward.
“This really makes heart failure recognized as a major part of the disease process. And with biomarkers and the cardio-kidney-metabolic framework, we can better predict and prevent progression,” she said.
A key message, Gulati stressed, is that heart failure prevention is not solely the job of cardiologists. With shared risk factors across diabetes, obesity, kidney disease and even liver disease, collaboration among endocrinologists, nephrologists, hepatologists and primary care physicians is essential.
Despite new drug options that improve outcomes and survival, many patients are still not receiving them. Gulati said this shows a new approach is needed for heart failure to replace the habit of simply sending the newly diagnosed patient to a heart failure specialist. She said there just are not enough specialists for the growing number of heart failure patients, so more needs to be done for prevention. This will require getting general practitioners and more cardiologists on board with identifying these patients earlier, which will lead to managing them better.
"I think the reaction has really been that, when a patient has heart failure, let's get them to the heart failure team," Gulati said. "But why are we waiting? Why are we waiting for advanced symptomatic heart failure? There's so much we can do, whether you're a primary care physician or a general cardiologist or a preventive cardiologist. By putting prevention at the center of heart failure care, we can change the way we talk about heart failure rather than treating it like the cancer of cardiology that is end stage, end of life. We should be really thinking about heart function and how we can preserve heart function and how can we improve somebody's trajectory across a healthy lifespan."
Watch the video above to hear more insights from Gulati.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]