New research from Karolinska Institutet in Sweden shows that patients with heart failure have high mortality and often are undertreated. According to a study, published in the scientific periodical JACC, many more of these patients would benefit from advanced treatment by heart specialists - something that could be decided by a simple evaluation of five common risk factors for early death due to heart failure.

Heart failure affects 2-3% of the overall population and over 10% of the elderly worldwide, and is associated with high risk for early death and reduced quality of life. Drug therapy improves symptoms and reduces mortality and is well used. However, modern heart failure pacemakers, heart pumps and also heart transplantation are of great benefit in selected patients, but are poorly utilized. Earlier studies have shown that, a major reason is that heart failure patients are generally cared for by generalist doctors with limited awareness of these treatments.

In the present study, a team comprising researchers at Karolinska Institutet, Linköping University, Stockholm South General Hospital and Karolinska University Hospital analysed data from 10,000 patients from the large Swedish Heart Failure Registry. First researchers showed that early death in these patients was related to heart failure (rather than for example age) suggesting that better treatment for heart failure would reduce mortality.

Second, the researchers defined 5 risk factors for mortality: poor pump capacity, poor kidney function, low blood count and absent treatment with the drugs ACE inhibitors and beta blockers. If any one of these risk factors was present in a given patient, the mortality was so high that the patient would potentially benefit from a heart failure pacemaker, heart pump and heart transplantation. This risk persisted after adjustment for a large number of other factors, such as patients age, general health and other factors.

“Currently, less than 5% of patients with heart failure receive heart failure pacemakers and many fewer receive heart pumps or transplantation. Our findings suggest that many more need these treatments and should be referred to heart failure specialists for evaluation”, says study leader Dr Lars H. Lund of Karolinska Institutet.

Karolinska Institutet and Stockholm County Council have initiated the cooperative ‘Project 4D’, aiming to improve knowledge building within healthcare and research regarding four diagnoses, among them heart failure. The current study was financed by the Swedish Heart-Lung Foundation, the Stockholm County Council and the Swedish Association of Local Authorities and Regions.

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Tonje Thorvaldsen, Lina Benson, Marcus Ståhlberg, Ulf Dahlström, Magnus Edner, Lars H. Lund
Triage of Patients with Moderate to Severe Heart Failure: Who Should be Referred to a Heart Failure Center?

Journal of the American College of Cardiology (JACC), online 25 October 2013, doi: 10.1016/j.jacc.2013.10.017

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Lars H. Lund

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