Key result
Heart failure with reduced ejection fraction has transformed into a chronic disease characterized by recurrent events, highlighting the need to include all events in clinical trial analyses.
Highlights the need to shift from 'time-to-first' event analyses to including all recurrent events in heart failure clinical trials, reflecting the modern chronic nature of the disease.
Not that long ago a diagnosis of heart failure was a death sentence. For example, a patient hospitalized with heart failure in the late 1980s had a median survival of <1.25 years after discharge. Those with reduced ejection fraction (HF-REF) died either from progressive pump failure or suddenly, mainly due to ventricular arrhythmias. This picture has been transformed in the past two decades. Angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and devices (implanted cardioverter defibrillators and cardiac resynchronization therapy) have completely changed the prognosis for patients with HF-REF. Systolic heart failure has been converted from a relatively short-term and quickly fatal condition to a chronic disease characterized by recurrent non-fatal events (hospital admissions) and delayed death that is now nearly as often due to a non-cardiovascular as a cardiovascular cause.
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Anker et al. (2012) conducted an editorial in Heart failure with reduced ejection fraction. Heart failure with reduced ejection fraction has transformed into a chronic disease characterized by recurrent events, highlighting the need to include all events in clinical trial analyses.
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