NHLBI Workshop
Data Needs for Cardiovascular Events, Management, and Outcomes
Heart Failure - Dr. Elizabeth Ofili
Heart failure poses significant health and financial burdens on patients and on
the society as a whole. The major cost-driver in heart failure is the high
incidence of hospitalizations. Patients with heart failure are at high risk for
hospitalizations and mortality, which has been estimated to be about 50% at five
years. Sudden cardiac arrest is the primary mode of death in mild to moderate
heart failure, and occurs at 6 to 9 times the rate of the general population.
Several guidelines have been developed on the management of heart failure,
including those established by the American College of Cardiology and the
American Heart Association. Nevertheless, marked gaps and variations exist in
the quality of care for heart failure; thus, many opportunities exist to improve
care for patients with heart failure. Despite overwhelming clinical-trial
evidence, expert opinion, national guidelines, and a vast array of educational
conferences, evidence-based, life-saving drug and device therapies continue to
be underutilized. Recommendations for medication and device therapies are
rapidly evolving, therapy is more complex, and collaboration among physicians
(primary care physicians, cardiologists, heart-failure specialists, and
electrophysiologists) can be challenging. New
approaches to improving the use of proven, guideline-recommended, life-saving
therapies are clearly needed.
Dr. Ofili also described gaps
in present knowledge concerning long-term care of heart failure. Specifically,
more long-term data are needed for the following: physicians’ use of
evidence-based medications; patient adherence to prescribed medications; how
comorbidities affect care; use of adequate dietary
counseling and patient adherence to dietary regimen; early care with escalating
symptoms; adequacy of discharge planning, outpatient follow-up, and outpatient
monitoring; patient social support systems; patient and care-giver needs, and
disparities in the care of minorities. She emphasized the need for
heart-failure surveillance, particularly one in which outpatient heart failure
as well as ethnic disparities in care can be clearly assessed.
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