Key Points
- The reasons for the increasing mortality rates related to HF are not clear. Despite publications and guidelines emphasizing timely initiation of guideline-directed
therapies, the implementation of these life-saving therapies has fallen short, potentially contributing to increasing mortality and hospitalization rates for HF, especially in the context of increased burden and risk of HF. - Coding guidelines do not consistently recognize HF as a primary underlying cause of death; rather, as a mediator between death and other diseases like coronary heart disease, hypertension, or cardiomyopathy. This likely leads to under-detection and significant under-reporting of HF-related deaths.
- There is a critical need for coding strategies to be updated to reflect new nomenclature and definitions. Addressing these issues underscores the urgent need for large-scale registries and research studies focused specifically on HF epidemiology, risk factors, and outcomes. It is essential to accurately capture HF as a primary cause of death to better understand its impact and inform effective public health strategies.
- Comprehensive population-based registries and outcome studies targeting populations at risk for HF, pre-HF stages, HF stages, including when patients reach advanced HF are lacking. These studies should also investigate specific etiologies of HF and cardiomyopathies, different EF subgroups, and take into account factors such as race/ethnicity, sex, gender, geography, SDoH, access and coverage in health care and structural inequities.
- Current data and population cohorts often provide fragmented information over time, limiting our ability to assess trends comprehensively. The authors recognize that existing cohorts represent specific patient populations, and findings may not be generalizable across different geographic and age groups.
- HF diagnostics, including biomarkers, molecular markers, imaging techniques, genetic profiling, and the role of artificial intelligence and machine learning are rapidly evolving and play a crucial role in HF care. These advancements will likely enhance risk detection, diagnosis, determination of specific etiologies, prognosis, and treatment personalization in HF.
- As risk factors for HF such as diabetes, obesity, metabolic syndrome, exposure to cardiotoxicity and population age continue to increase, the burden of HF is expected to rise.