Need for new research strategies
Heart failure (1) constitutes a pandemic that affects twenty-six million people worldwide and leads to millions of hospitalisations. More than 2% of the world's population suffer from heart failure. It is estimated that there are 15 million patients in Europe and about 1 million patients in Italy, one fourth of whom are under 65 years of age. There are about 180 thousand people with heart failure in the region of Lombardy, of whom more than 20 thousand in the city and province of Bergamo. According to recent estimates, the number of patients will increase progressively and double by 2020. The disease's prevalence increases with age, and the continuously rising percentage of elderly people in the population is part of the reason for the growing incidence of heart failure. In fact, it is estimated that its frequency doubles with each decade of age (after 65 years it reaches about 10%).
«Heart failure is one of the main medical causes for hospitalisations. For this reason it is considered a significant public-health problem with exceedingly high costs for the National Health Service: each year, more than 500 million euros are spent for hospitalisations with a diagnosis of heart failure, equal to about 3% of the total costs incurred by the National Health System» Antonello Gavazzi, cardiologist of the FROM Research Foundation at the Pope John XXIII Hospital, explains during the meeting "Heart Failure at Crossroads" organised by the FROM and by the Pope John XXIII Hospital of Bergamo and sponsored by the Fondazione Internazionale Menarini. «Despite the availability of new treatments and efficient drugs, people with heart failure have unacceptably high mortality and re-hospitalisation rates, percentages that have not dropped during the last few years» Michele Senni, head of the Cardiology department at the Pope John XXIII Hospital, adds.
It is therefore important to reassess current knowledge to identify the differences between the various types of patients in order to "pinpoint the physiopathological mechanisms at work in each individual" within the syndrome of heart failure. Patients with diabetes are a typical example. In these patients, heart failure develops with specific metabolic, functional, neurohormonal and haemodynamic changes so that the disease may respond differently to treatment. As a result, mortality due to heart failure is higher in diabetics than in people without diabetes.
Numerous epidemiological studies in the past years have shown that nearly half of all patients hospitalised for heart failure show a preserved left-ventricular ejection fraction. For patients with heart failure with reduced ejection fraction, numerous controlled clinical trials have shown the efficacy of various drugs in reducing morbidity and mortality, for example beta blockers, ACE inhibitors, sartans and mineralocorticoid receptor inhibitors. On the other hand, to date there are no efficient treatments for patients with heart failure with preserved ejection fraction. Given the above, the therapeutic approach cannot be identical for all patients with heart failure, but rather new drugs specifically for this type of heart failure must be identified and tested. Whenever the underlying cause cannot be corrected, the prognosis of heart failure is unfavourable and is the same for heart failure patients both with preserved and with reduced ejection fraction. About half of all patients with a diagnosis of heart failure die within four years, while half of the patients affected by advanced heart failure die within one year. Advanced heart failure affects about one quarter of patients with this disease treated in hospitals. In Italy it has an estimated incidence of 12,000 new cases each year.
Unfortunately, in the case of advanced heart failure, changing the high mortality rate is difficult, the symptoms are invalidating and the quality of life is severely compromised. Contrary to the trend for other common heart diseases, mortality related to heart failure does not appear to be on the decrease.
«It is essential to take stock of the current state of knowledge about heart failure and carry out a critical re-examination to pave the way for research and clinical practice in the years to come» Prof. Mihai Gheorghiade of the Center for Cardiovascular Innovation at Northwestern University in Chicago (USA) states. «This is the main purpose of the "Heart Failure at Crossroads" meeting.»
(1) Heart Failure is a chronic illness that appears when a damaged heart is no longer able to carry out its normal pumping function and to maintain a sufficient blood flow in the body. As a result, organs and tissues receive insufficient amounts of oxygen for their metabolic needs. The body's reaction to the insufficient heart function causes an accumulation of sodium and water in the lungs and tissues. The consequences of this are shortness of breath, reduced tolerance of exertion, tiredness, oedema (that is swelling). The condition may worsen even to the point of acute pulmonary oedema and death.