A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms

Abstract

Heart failure (HF) is commonly described according to the severity of symptoms, using the New York Heart Association (NYHA) classification, and the assessment of ventricular function, by measuring the left ventricular ejection fraction (LVEF). It is important to acknowledge, however, that the severity of symptoms does not systematically correlate with the level of ventricular systolic dysfunction. Patients with no or only mild symptoms are still at high risk of HF-related morbidity and mortality. The objective of this review was to summarize the prevalence, characteristics, and treatment of patients with chronic HF and mild or no symptoms and to review epidemiological data from three recent registries conducted in Europe. From a clinical practice perspective, patients with a reduced ejection fraction who have only mild symptoms appear to represent a group of patients for whom the provision of adequate medical care is yet to be optimized. While prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers appears to be consistently high, the use of mineralocorticoid receptor antagonists is more variable and does not appear to be in accordance with the latest clinical guidelines. As approximately half of patients with HF and a reduced LVEF have NYHA class II symptoms, significant reductions in morbidity and mortality could be achieved by more comprehensive treatment of this population.

Pentraxin-3 Predicts Long-Term Cardiac Events in Patients with Chronic Heart Failure

“…This association and the higher specificity of PTX3 for localized inflammation in the cardiovascular system [ 10 , 11 ] might be responsible for the superior prognostic value of PTX3. In addition, our findings that age, NYHA class >II, and cTnI were also independently associated with cardiac events in CHF patients are consistent with the data in previous studies [ 20 – 22 ].…”

The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

“…Additional research is needed to evaluate ambulatory metrics (in addition to pulmonary pressures) of volume status, which might allow easier adaptation of loop diuretic therapy. Registry data indicate that mildly symptomatic heart failure patients [New York Heart Association (NYHA) class I and II] are generally treated with similar doses of loop diuretics as more symptomatic heart failure patients (NYHA class III and IV) . This underscores the importance to re‐assess loop diuretic need following the initiation of therapies that improve cardiac status (such as cardiac resynchronization therapy or sacubitril/valsartan) .…”

“…Registry data indicate that mildly symptomatic heart failure patients [New York Heart Association (NYHA) class I and II] are generally treated with similar doses of loop diuretics as more symptomatic heart failure patients (NYHA class III and IV). 134 This underscores the importance to re-assess loop diuretic need following the initiation…”

Cardiac Device Therapy in Heart Failure: Between Guidelines and Current Practice. Where Are We?

“…The fact that the issue is topical all over the world had been proven by similar registries from France, Spain and Germany with somewhat different results. 8 However, in Iraq, it is only recently when locally conducted audits started to focus on medical therapy in heart failure in general, 9,10 yet, current audit highlights the remarkable non-adherence to guidelines in applying GDMT (in terms of prescription and dose up-titration) in particular group of HF patients; those with HFrEF prior to implantation of cardiac device therapy. In heart failure, ventricular arrhythmias are common and can range from asymptomatic premature ventricular contractions to sustained arrhythmias such as ventricular tachycardia (VT), ventricular fi brillation (VF), or SCD.…”