Improved Understanding of Heart Failure

EP: 1.Heart Failure Clinical and Economic Burden

EP: 2.The Progressive Nature of Heart Failure

EP: 3.Link Between LVEF, NT-ProBNP and Cardiac Remodeling

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EP: 4.Improved Understanding of Heart Failure

EP: 5.Treatment Goals for Patients With Heart Failure

EP: 6.The HFrEF Standard of Care

EP: 7.Heart Failure Management Unmet Needs

EP: 8.Utilization Management Strategies for Appropriate Treatment

EP: 9.Challenges in the Management of HFpEF

EP: 10.Differences in Standard of Care: HFpEF vs HFrEF

EP: 11.Ensuring Timely and Appropriate Access to Therapy

EP: 12.Differences in Economic Burden: HFpEF and HFrEF

EP: 13.PROVE-HF Trial Overview

EP: 14.PARAGON-HF Trial Overview

EP: 15.Recent Findings from the PARALLAX Study

EP: 16.Promising Findings From the TOPCAT Study

EP: 17.Differences in Leading Treatments for Heart Failure

EP: 18.When to Add an SGLT2 Inhibitor to Treatment Regimen

EP: 19.Heart Failure Sites of Care

EP: 20.How Approved Agents Will Change the Standard of Care

EP: 21.Heart Failure Management During COVID-19

John McMurray, MBChB: We’ve learned a lot about heart failure in the last 2 decades. Even just in the past 5 or 6 years, we’ve made great breakthroughs. Our major advance has been understanding how to treat 1 of 2 major heart failure phenotypes or subgroups. Those are patients who got heart failure with a reduced ejection fraction where the problem is with the contracting and the emptying of the left ventricle of the heart. We now have many pharmacological drugs and treatment devices for that type of heart failure.

What we have not advanced much with is the management of the other major phenotype, which is heart failure with preserved ejection fraction, where the problem is 1 of impaired relaxation and filling of the left ventricle. A pump has to both fill and empty to work properly. We haven’t had any major breakthroughs there, though there has been a conceptual breakthrough in the sense that we realize that heart failure with preserved ejection fraction is probably at least 2 different subtypes of heart failure.

There are individuals who have completely normal ejection fraction where the emptying—the pumping—of the heart is normal, and there are people who have pumping or an ejection fraction that is not normal. But it’s not low, so it’s not in that former heart failure group with reduced ejection fraction. For people who have an ejection fraction below normal but not very low, we are beginning to realize that those patients may constitute a distinct phenotype.

Those individuals may benefit from some of the treatments that we know work in people with a reduced ejection fraction. Maybe we will soon begin to see an expansion of the use some of the treatments we have for heart failure with reduced ejection fraction to a proportion of patients with heart failure with preserved ejection fraction. Some people call those individual patients with heart failure in midrange a mildly reduced ejection fraction.