November 2019 at a Glance. Chronic and Acute Heart Failure: From Epidemiology to Treatment

Frailty is common in heart failure (HF) patients. It is associated with increased risk of cardiovascular events and reduced response to medical therapy.1 Vitale et al.2 proposed a new definition of frailty and provided tools to identify and quantify it in HF patients. Mortality in chronic HF is still comparable to cancer.3 A meta-analysis of 60 studies with survival data for 1.5 million people with HF showed survival rates at 5 and 10 years of 56.7% and 34.9%, respectively. However, survival improved in these years and was greater in young patients and in secondary care centres.4 Results from the China Hypertension Survey showed a prevalence of HF and left ventricular (LV) dysfunction in a Chinese adult population of 1.3% and 1.4%, respectively. No differences were observed between urban and rural residents and between men and women. Treatment of hypertension was ineffective.5 Sacubitril/valsartan has a main role in the treatment of chronic HF.6 Kapelios et al.7 investigated the prevalence of eligibility for sacubitril/valsartan and its association with outcomes in patients with HF and reduced ejection fraction (HFrEF). Eligibility criteria were met in 84%, 12% and 28% of the population according to the European Medicines Agency/Food and Drug Administration, PARADIGM-HF trial and European Society of Cardiology guidelines, respectively. Eligible patients had greater HF hospitalization but lower mortality than the PARADIGM-HF control arm. Sodium–glucose co-transporter 2 inhibitors improve prognosis of HF patients.8 McMurray et al.9 reported the baseline characteristics of patients included in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial. They were similar to those included in other contemporary HF studies, though with better background therapy. Patients with diabetes had worse HF status, more co-morbidity, and greater renal impairment but received similar HF therapy. More than 400 patients with HFrEF were randomized to once daily oral neladenoson bialanate at different dosages or placebo.10 After 20 weeks of treatment, there was no effect of neladenoson bialanate on changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) or LV ejection fraction (primary endpoints) or in LV volumes, troponin T, cardiovascular mortality, and HF hospitalization. Worsening of renal function was observed in treated patients.11 Clinical profile of acute HF patients affects outcomes.12 Chioncel et al.13 and Javaloyes et al.14 reported prevalence and prognostic impact of clinical phenotypes based on perfusion and congestion status. The phenotype ‘wet–warm’ was the most commonly observed. Hypoperfused (cold) phenotypes had higher in-hospital mortality, while congestive (wet) phenotypes had higher risk of prolonged hospitalization but had lower risk of rehospitalization. Residual congestion at discharge is an independent predictor of 1-year mortality. Incidence of cardiogenic shock increased between 2012 and 2017 in the Danish population. An increase in non-ST-elevation myocardial infarction and LV dysfunction and a decrease in ST-elevation myocardial infarction presentation were noted. Annual 30-day mortality remained unchanged.15 In acute HF patients at high risk for diuretic resistance, the addition of acetazolamide to loop diuretics may improve decongestion.16 Among 34 patients randomized to acetazolamide plus loop diuretic or high dose of loop diuretic, natriuresis after 24 h (primary endpoint) did not differ in the two groups. However, loop diuretic efficiency as well as renal function impairment were higher in the group receiving acetazolamide.17 More than 90% of elderly patients (≥70 years) admitted for HF are unable to perform six specific tasks (use of a scale, weight registration, diuretic identification, knowledge of salted foods, oedema identification, and treatment adjustment) needed for HF self-care. Self-perception of care, detected by specific questionnaires, was poorly correlated with real ability. Poor self-care ability was associated with an increased risk of 1-year mortality.18 Telemedical Interventional Management in Heart Failure II (TIM-HF2) investigated the prognostic impact of telemedicine in HF patients.19 Möckel et al.20 showed that the combined use of mid-regional pro-adrenomedullin and NT-proBNP could be used to identify low-risk patients unlikely to benefit from remote patient management.