Update on heart failure management and future directions

Abstract

Heart failure (HF) is an important cardiovascular disease because of its increasing prevalence, significant morbidity, high mortality, and rapidly expanding health care cost. The number of HF patients is increasing worldwide, and Korea is no exception. There have been marked advances in definition, diagnostic modalities, and treatment of HF over the past four decades. There is continuing effort to improve risk stratification of HF using biomarkers, imaging and genetic testing. Newly developed medications and devices for HF have been widely adopted in clinical practice. Furthermore, definitive treatment for end-stage heart failure including left ventricular assist device and heart transplantation are rapidly evolving as well. This review summarizes the current state-of-the-art management for HF and the emerging diagnostic and therapeutic modalities to improve the outcome of HF patients.

Keywords: Diagnosis; Heart failure; Management; Prognosis.

Figure 1.

Global epidemiology of heart failure.

Figure 2.

Epidemiology of heart failure in Korea according to (A) years and (B) age and sex. Adapted from Lee et al. [7].

Figure 3.

Progression of heart failure treatment: medications, devices, and transplantation. HT, heart transplantation; TAH, total artificial heart; V-HeFT, Vasodilator-Heart Failure Trial I; CONSENSUS, Cooperative North Scandinavian Enalapril Survival Study; SOLVD, Studies of Left Ventricular Dysfunction; USCP, U.S. Carvedilol Program; RALES, Randomized Aldactone Evaluation Study; ATLAS, Assessment of Treatment with Lisinopril and Survival; MADIT, Multicenter Automatic Defibrillator Implantation Trial; MUSTT, Multicenter Unstained Tachycardia Trial; VAD, ventricular assisted device; MMF, mycophenolate mofetil; CHARM, Candesartan in Heart failure-Assessment of moRtality and Morbidity; SHIFT, Systolic Heart failure treatment with the I_f inhibitor ivabradine Trial; PARADIGM-HF, Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in HF; EMPA-REG, Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus; CANVAS, Canagliflozin Cardiovascular Assessment Study; LEADER, Liraglutide Effect and Action in Diabetes : Evaluation of Cardiovascular Outcome Results; CANTOS, Canakinumab Anti-inflammatory Thrombosis Outcome Study; ATTR-ACT, Transthyretin Amyloidosis Cardiomyopathy Clinical Trial; DECLARE, Dapaglif lozin Effect on CardiovascuLAR Events; DEFINITE, Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation; DINAMIT, Defibrillator in Acute Myocardial Infarction Trial; COMPANION, Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure; SCD-HeFT, Sudden Cardiac Death in Heart Failure Trial; CARE-HF, Cardiac Resynchronization in Heart Failure; REVERSE, REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction; MADIT-CRT, Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy; RAFT, Resynchronization–Defibrillation for Ambulatory Heart Failure Trial; STICH, Surgical Treatment for Ischemic Heart Failure; DANISH, Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality; VEST, Vest Prevention of Early Sudden Death Trial; REMATCH, Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure; mTOR, mammalian target of rapamycin; HVAD BTT, HeartWare ventricular assist device bridge to transplant; HMII-DT, HeartMate II destination therapy; SCHEDULE, Scandinavian Heart Transplant Everolimus De novo study with Early Calcineurin Inhibitors Avoidance; PROCEED II, ex vivo perfusion of donor hearts for human heart transplantation; ENDURANCE, The HeartWare™ Ventricular Assist System as Destination Therapy of Advanced Heart Failure; MOMENTUM 3, Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3; ICD, implantable cardioverter-defibrillator; CRT, cardiac resynchronization therapy.

Figure 4.

Temporal trends of cardiac implantable electronic device implantation in Korea. ICD, implantable cardioverter-defibrillator; CRT-P, cardiac resynchronization therapy without defibrillator; CRT-D, cardiac resynchronization therapy with defibrillator.

Figure 5.

Adverse events of left ventricular assist devices. The data of HeartWare ventricular assist device (HVAD) and Heartmate 3 (HM 3) were quoted from different clinical trials, so direct comparison of adverse event rates is inappropriate. GI, gastrointestinal.

Figure 6.

Adverse events of heart transplantation: within 1 year and after 5 years. HT, heart transplantation; MOF, multi-organ failure; CAV, cardiac allograft vasculopathy.