Dr. Carolyn S.P. Lam
Two recent reports of U.S. data documented that the increasing prevalence of HFPEF is outpacing that of HFREF by 1% per year, driven by the aging of the American population (older age is a risk factor for HFPEF) and by the increasing prevalence of comorbidities that contribute to HFPEF. One of the reports, based on U.S. national data collected by the Get With the Guidelines Program, extrapolated that by the end of this decade about 65% of all patients hospitalized for heart failure will have a left ventricular ejection fraction of 40% or greater, the vast majority with HFPEF (Curr. Heart Fail. Rep. 2013;10:401-10). What’s coming is a HFPEF "epidemic," said Dr. Lam, a cardiologist at the National University Heart Centre in Singapore.
The fact that HFPEF is now at least as prevalent as HFREF, that it is about as lethal independent of what comorbidities might contribute, and that it is growing more prevalent than HFREF sharply contrasts with the absence of treatments with proven efficacy. How did that happen?
"Research into HFPEF is decades behind research into HFREF," said Dr. Fonarow. "HFPEF was largely ignored because the prevailing wisdom [20 or so years ago] was that it represented only a small proportion of cases and that outcomes were much better compared with HFREF." Only with registry data and community-based studies run more recently did cardiologists realize that outcomes from HFPEF were as bad as from HFREF. Progress was further hampered by enrollment of patients who did not have HFPEF or a broad spectrum of patients unable to respond equally well to the treatment under study.
"There are large gaps in knowledge of the pathophysiology of HFPEF and little investment has been made to identify potential therapeutic targets. This creates cascading levels of challenges for developing effective treatments despite the massive unmet need," said Dr. Fonarow.
"We don’t know what to treat yet," was Dr. Teerlink’s summation of the HFPEF dilemma.
Dr. Borlaug said that he has been a consultant to GlaxoSmithKline, Merck, Amgen, CardioKinetix, and DC Devices and has received research support from Atcor. Dr. Solomon said he has been a consultant to and received research support from Novartis and more than 10 other drug and device companies. Dr. Pieske said that he has received honoraria from Bayer, Boehringer Ingelheim, Servier, Medtronic, Bristol-Myers Squibb, Menarini, and Novartis and received research support from Bayer and Medtronic. Dr. Shah said that he has been a consultant to Novartis, Bayer Schering, and the Pulmonary Hypertension Association. Dr. Fonarow said that he has been a consultant to Medtronic, Novartis, and Pfizer. Dr. Teerlink said that he has been an adviser to and received research support from Novartis. Dr. Cleland said that he has received honoraria from Novartis and research funding from Pfizer. Dr. Lam said that she has been a consultant to Bayer, Novartis, and DC Devices and has received research support from Boston Scientific, Medtronic, and Vifor Pharma.
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