Perspectives on heart failure

Irish Cardiac Society, 71^st Annual Scientific Meeting, 1-3 October 2020

Due to the virtual nature of this year’s ICS Scientific Meeting, attendance was increased compared to previous years and delegates had access to oral abstracts, general posters and moderated posters that covered all aspects of cardiology, from valve replacement and balloon angioplasty, to cardiac toxicity and hypertension, as well as a range of other specialist subjects.
Several abstracts and posters also presented data on various aspects of heart failure (HF). One of the poster presentations by Drs Ronan Cusack, Avinash Radhakrishna and John Barton of the Department of Cardiology at University Hospital Galway was titled ‘Treatment of heart failure in 2020: CHAMPs or Chumps?’

The authors conducted an audit of prescribing trends in a tertiary referral centre at University Hospital Galway, within a specialist-led heart failure outpatient clinic service “to evaluate our performance in comparison to these large studies”. In their conclusion, the authors noted: “Despite the strong body of evidence underpinning GDMT, gaps in prescribing habits still exist with specialist heart failure outpatient services.”

They observed that despite compelling evidence, there is low usage of SGLT2 inhibitors and this “is likely explained in part [due] to the lack of established guidelines on its optimal use within treatment algorithms. We would expect this to be addressed in the next update to the European Cardiology Society (ESC) Guidelines for Acute and Chronic Heart Failure.”
Another poster presentation entitled ‘A review of patients with heart failure with mid-range ejection fraction (HFmrEF): Comorbidities and outcomes’ was delivered by researchers from the Department of Cardiology, St James’s Hospital, Dublin.

The researchers sought to compare the comorbidities of HFmrEF patients with those of HFpEF and HFrEF patients, and aimed to compare hospitalisations for acute decompensation HF, and mortality between these groups. The participants comprised 286 new patients referred to one of three HF clinics. In their conclusion, the authors wrote: “In our cohort of annual referrals to our three HF clinics, comorbidities were similar in HFmrEF as compared with HFpEF and HFrEF, aside from previous CABG surgery (in which there were fewer in HFmrEF as compared with HFpEF and HFrEF) and HTN (of which there were more in HFpEF). There was a numerically higher proportion of devices in the HFrEF group.

“Mortality was similar across the three groups over our follow-up period of 17.5 months, and there was no difference in mean hospitalisations for ADHF between the groups. In our catchment area, our HFmrEF have a similar phenotype to our HFpEF and HFrEF cohorts.”

Among the other presentations focused on HF was an oral presentation by Ms Loreena Hill, Lecturer in the School of Nursing and Midwifery at Queen’s University Belfast, on ‘Heart failure patient and caregiver needs and expectations regarding self-management via digital health – the PASSION-HF project’. Ms Hill and colleagues sought to assess the needs and requirements of HF patients and their informal caregivers in regard to a virtual doctor. The study was conducted against the backdrop that HF healthcare services are not sufficient to meet the needs of an ageing population with increasing comorbidities and disease complexity, together with the unequal distribution of medical care in rural and urban regions. Taken together, these factors have resulted in an imminent need to identify alternative healthcare approaches, said Ms Hill.

Using an exploratory mixed-method study within The Netherlands, UK, Ireland, and Germany, qualitative, guided interviews were supplemented by a standardised questionnaire in the study. In their conclusions, the authors wrote: “Patients want reassurance 24/7, independently of the availability of healthcare services, combined with personalised medical advice regarding day-to-day management of their HF. In a next step, we are planning a multi-centre clinical trial to test the first prototype of the e-health product (DoctorMe).”