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The war on heart failure The not-so-good news – challenges • >5.8M HF pts in US • >1M hospitalizations/yr • Most common hospital admission diagnosis in Medicare pts • Demographic imperactive; with continuation of current incidence → >50% new pts/yr in 2030 Heart failure is common North America 1.5% Canada 1.9% USA EUROPE ~1-2% France 2.2% UK 1.3% ASIA Chin a Japa n Malaysia Singapore 1,3% ~1% 6.7 % 4.5 % H H H Latin America No population based estimates Africa No population based estimates Middle East Oman 0,5% Australasia Australia 0,5% Proportions of HF hospital admissions as the primary diagnosis North America (2 countries) 1.8 – 3.0% Europe (22countries) 0.3 – 3.7% Asia (3 countries) 0.8 – 1.2% Latin America (3 countries) 1.6-2.1% Africa (1country) 0,7% Middle East (2ountries) 1.3% Australasia (2countries) 1,4 – 1.5% The burden of heartfailure NUMBER of PATIENTS 21 MILLION adults worldwide are living with heart failure This number is expected to rise.1,2 ECONOMIC BURDEN In 2012, the overall worldwide cost of heart failure was nearly $108 BILLION.6 MORTALITY 50% of heart failure patients die within years from diagnosis.5 REHOSPITALISATION Heart failure is the NUMBER cause of hospitalisation for patients aged >65 years.4 COMORBIDITIES: The vast majority of HF patients has or more comorbidities Mozaffarian D et al Circulation 2015;131(4):e29-e322 Mosterd A et al Heart 2007;93(9):1137-1146 http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf Cowie MR et al Oxford PharmaGenesis; 2014 http://www.oxfordhealthpolicyforum.org/AHFreport Accessed February 18, 2015 Fauci AS et al Harrison's Principles of Internal Medicine 17th ed New York: McGraw-Hill; 2008 Cook C et al Int J Cardiol 2014;171(3):368-376 ESC registry Acute HF Re-hospitalizations during the follow-up* Causes of hospitalization No 56.1 % Yes 43.9 % 17,0% 56,4% 26,6% Non CV causes *median follow-up 349 days [252-365] Maggioni AP, et al Eur J Heart Fail 2013;15:808–817 CV causes non HF HF Heart failure patients suffer from recurrent hospitalization With each hospitalization, there is likely myocardial and renal damage which contributes to ventricular progressiveorleftrenal dysfuncti leading to an on, inevitable downwa spiral.1 rd Gheorghiade M et al Am J Cardiol 2005;96:11-17 Meanlength of hospital stay increases with each rehospitalization forHF Length of hospital stay following hospitalization for HF Mean length of stay (days) 8.5 8.0 7.5 All HF HFrEF HFpEF Acute HF Chronic HF 7.0 6.5 6.0 First Second Third Hospitalization Fourth Fifth Korves et al Presented at the American Heart Association Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke 2010 Scientific Sessions, Washington, D.C., May 19–21, 2010 278,307 patients in the USA with ≥1 hospitalization with a HF claim were followed from first HF hospitalization for 24 months or until disenrollment or end of data availability Three-phase terrain of lifetime readmission risk after Heart Failure Hospitalization periods of highest risk for readmission unavoidable readmissions VULNERABLE PHASE Evidence-based strategies needed to prevent readmission www.escardio.org/guidelines Desai AS and Stevenson LW Circulation 2012;126:501-506 Elevated heart rate at hospital discharge predicts one-year mortality (OFICA) Survival (%) 41% increase in one-year mortality1 P = 0.01 N=1658 (170 hospitals); Mean HR at discharge:71 bpm; year mortality: 33% Time (days) Logeart D et al Raised heart rate at discharge after acute heart failure is an independent predictor of one-year mortality Eur Heart J 2012;33(Abst Suppl):485 [ABSTRACT] EMPA-REG Outcome Trial N Engl JMed 2015;373:2117 EMPA-REG OUTCOME® Placebo (n=2333) Trial design Screening Randomized &treatet (n=11531) (n=7020) Empagliflozin 10mg (n=2345) Empagliflozin 25 mg • • • • Study medication was given in addition to standard of care Primary outcome: 3-point MACE Analysis: Placebo vs pooled empagliflozin groups Key inclusion criteria: – Adults with type diabetes and established CVD – BMI ≤45 kg/m2; HbA1c 7–10%; eGFR ≥30 mL/min/1.73m2 (MDRD) Zinman B et al N Engl J Med 2015;373:2117-28 Primary outcome: 3-point MACE HR 0.86 (95.02% CI 0.74, 0.99) p=0.0382* Zinman B et al N Engl JMed 2015;373:2117 19 CV death HR 0.62 (95% CI 0.49, 0.77) p