George Godfrey
Head of Medical – Cardiology, AstraZeneca
Right now in the UK, almost one million people are living with heart failure, a condition where a person’s heart cannot pump enough blood to their organs – with heart failure mortality risk being worse than some of the most common cancers (prostate, breast, and bladder cancer).1,2,3 Globally, the number of people living with heart failure rises to 64 million people.4 Yet, despite its prevalence and the fact that around half of people with heart failure in the UK will die within five years of their diagnosis, the majority of people aren’t aware of what heart failure means, making it an often overlooked condition.4,5
New research conducted by the World Heart Federation, and commissioned by AstraZeneca, has thrown this awareness gap into the open; while the majority of people surveyed had heard of heart failure, only around a quarter were able to identify two of the main symptoms, such as shortness of breath when resting or being active, or swelling of the feet, ankles, legs, abdomen or in the small of the back.4
Lack of awareness of heart failure symptoms
A common misconception is that heart failure only affects the elderly.6 Although heart failure prevalence does increase with age, it can occur in younger patients too.4 This lack of understanding can contribute to delayed diagnosis and treatment, with one study suggesting that patients can wait more than two and a half years between first symptoms and diagnosis.7
Part of the problem is that heart failure symptoms can often be attributed to other, less serious conditions, making it difficult for doctors to make a clinical assessment recognising these as being connected to heart failure.8,9 When you add the current awareness gap on understanding what heart failure is and how it can affect us, we are more likely to ignore symptoms and not seek medical advice. This vicious circle can result in delayed diagnosis, treatment, and ultimately worse outcomes.
Heart failure usually linked to other conditions
So how do we address this gap? This question spans a multitude of institutions, industries, and ideas, but a starting point is understanding that heart failure is usually linked to other medical conditions, particularly cardiovascular disease, diabetes, and kidney disease. For example, if you already have conditions such as high blood pressure, chronic kidney disease, or diabetes, you have a higher chance of developing heart failure and other associated cardiovascular disorders too.10,11,12 Men and women with diabetes are estimated to have a two- and five-times increased risk of developing heart failure respectively, when compared to non-diabetics.13
Despite its prevalence and the fact that around half of people with heart failure in the UK will die within five years of their diagnosis, the majority of people aren’t aware of what heart failure means, making it an often overlooked condition.
We are continuing to build up a more comprehensive understanding of the links between diabetes, kidney disease and cardiovascular diseases. Although there have been significant advances in treatment and prevention, mortality remains high and we are dedicating our efforts to bringing awareness of heart failure to the forefront and highlighting the importance of tackling heart failure.2 Understanding the interconnectedness between these conditions gives us an opportunity to find more holistic approaches, that may ultimately help prevent or alleviate symptoms and maintain quality of life in those already living with or at risk of heart failure. Lifestyle changes such as exercising regularly and having a balanced diet can improve symptoms.14
Better knowledge and understanding of heart failure will lead to improved management and prevention.15 By knowing the symptoms and risk factors for heart failure, people can visit their doctor earlier and ask the right questions, potentially cutting the time to diagnosis and care, and – when partnered with improvements in patients being treated – potentially improving their outcomes as well.16
Now is the time for change. By raising awareness of how it can make people feel, how it can shorten their lives if diagnoses are late and how other common medical conditions can cause it, we can shine a spotlight on heart failure and make a difference to the lives of people living with or at risk of developing the condition.
GB-24137 | September 2020
[1] Sutherland, K., 2010. Bridging the quality gap: heart failure. Health Foundation. [2] Savarese G and Lund LH. 2017. Global public health burden of heart failure. Cardiac Failure Review 3(1): 7-11. [3] Mamas MA. 2017. Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. European Journal of Heart Failure 19(9): 1095-1104. [4] AstraZeneca, World Heart Federation. Accelerate change together: heart failure gap review. Available at: https://www.world-heart-federation.org/resources/accelerate-change-together-heart-failure-gap-review/ Last accessed September 2020. [5] Taylor CJ et al. 2019. Trends in survival after a diagnosis of heart failure in the United Kingdom 200-2017: population based cohort study. British Medical Journal 364:1223. [6] Pumping Marvellous. Debunking common heart failure myths. Available at: https://pumpingmarvellous.org/debunking-common-heart-failure-myths/ Last accessed September 2020. [7] Hayhoe B et al. 2019. Adherence to guidelines in management of symptoms suggestive of heart failure in primary care. Heart 105: 678–685. [8] NHS. Symptoms: Heart failure. Available at: https://www.nhs.uk/conditions/heart-failure/symptoms/ Last accessed September 2020. [9] Fuat A et al. 2018. A Qualitative Study of Accurate Diagnosis and Effective Management of Heart Failure in Primary Care. American Journal of Cardiology and Cardiovascular Diseases. 1(1)01-05. [10] British Heart Foundation. High blood pressure. Available at: https://www.bhf.org.uk/informationsupport/risk-factors/high-blood-pressure Last accessed September 2020. [11] House et al. 2019. Heart failure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International 95:1305-1317. [12] Nichols GA et al. 2001. Congestive Heart Failure in Type 2 Diabetes. Prevalence, Incidence and Risk Factors. Diabetes Care 24:9. [13] Kenny et al. 2018. Heart Failure in Type 2 Diabetes Mellitus: Impact of Glucose-Lowering Agents, Heart Failure Therapies, and Novel Therapeutic Strategies. Circulation Research 124:121–141. [14] NHS. Living with heart failure. Available at: https://www.nhs.uk/conditions/heart-failure/living-with/ Last accessed September 2020. [15] Wang J et al. 2015. Early Detection of Heart Failure with Varying Prediction Windows by Structured and Unstructured Data in Electronic Health Records. Conference proceedings – IEEE engineering in medicine and biology society 2015: 2530–2533. [16] Remme WJ et al. 2005. Public awareness of heart failure in Europe: first results from SHAPE. European Heart Journal 26:22.
