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New Therapies for Heart Failure: A Managed Care Perspective

Addressing the Clinical and Economic Impact of Heart Failure

Heart failure (HF) imposes one of the highest burdens of any medical condition in the United States.1 It is a chronic condition affecting approximately 6 million adults in the United States, and it is associated with more than 83,000 deaths annually, according to data from 2015 to 2018.2 Furthermore, the prevalence of HF is expected to rise to over 8 million (or 1 in 33) US adults by 2030, mirroring the aging population.2,3 Despite substantial recent advances in medical therapy for HF, associated morbidity remains high, and quality of life (QOL) of affected patients is poor.4 The clinical burden of HF is exacerbated by the occurrence of severe comorbid conditions (present in over 70% of patients) that are independently associated with increased risk of death, functional limitation, and QOL impairment.5 The 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guideline for the Management of Heart Failure reflects our improved understanding of HF pathogenesis, patient phenotypes, and use of effective therapies.6 Despite these advances, adoption of guideline-directed medical therapy (GDMT) remains suboptimal for several reasons (eg, insufficient uptake by health care providers) and/or patient-related issues (eg, medication adverse effects, low adherence to medications, socioeconomic factors).7-10 This supplement includes 3 articles that examine the challenges and opportunities of treating HF from a managed care perspective and provides an overview of treatment approaches for HF with reduced ejection fraction.11-13 It ultimately culminates in a discussion of ways to improve access to care for all patients with HF.

Funding Source: Publication of this supplement was supported by Boehringer Ingelheim Pharmaceuticals, Inc. and Lilly USA, LLC.

References

  1. Benjamin EJ, Virani SS, Callaway CW, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67-e492. doi:10.1161/CIR.0000000000000558
  2. Virani SS, Alonso A, Aparicio HJ, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254-e743. doi:10.1161/CIR.0000000000000950
  3. Heidenreich PA, Albert NM, Allen LA, et al; American Heart Association Advocacy Coordinating Committee; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Stroke Council. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606-619. doi:10.1161/HHF.0b013e318291329a
  4. Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev. 2017;3(1):7-11. doi:10.15420/cfr.2016:25:2
  5. Ambrosy AP, Stevens SR, Al-Khalidi HR, et al; STICH Trial Investigators. Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy.
    Eur J Heart Fail. 2019;21(3):373-381. doi:10.1002/ejhf.1404
  6. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-e421. doi:10.1016/j.cardfail.2022.02.010
  7. Greene SJ, Butler J, Albert NM, et al. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF Registry. J Am Coll Cardiol. 2018;72(4):351-366. doi:10.1016/j.jacc.2018.04.070
  8. Fiuzat M, Ezekowitz J, Alemayehu W, et al. Assessment of limitations to optimization of guideline-directed medical therapy in heart failure from the GUIDE-IT trial: a secondary analysis of a randomized clinical trial. JAMA Cardiol. 2020;5(7):757-764. doi:10.1001/jamacardio.2020.0640
  9. Smith KV, Dunning JR, Fischer CM, et al. Evaluation of the usage and dosing of guideline-directed medical therapy for heart failure with reduced ejection fraction patients in clinical practice. J Pharm Pract. 2022;35(5):747-751. doi:10.1177/08971900211004840
  10. Bassi NS, Ziaeian B, Yancy CW, Fonarow GC. Association of optimal implementation of sodium-glucose cotransporter 2 inhibitor therapy with outcome for patients with heart failure. JAMA Cardiol. 2020;5(8):948-951. doi:10.1001/jamacardio.2020.0898
  11. Sen S. Heart failure with reduced ejection fraction: clinical and economic burden and insights into current and emerging treatments. Am J Manag Care. 2023;29:S180-S186. doi:10.37765/ajmc.2023.89415
  12. Kumar S, Psotka MA. Heart failure without a reduced ejection fraction. Am J Manag Care. 2023;29:S187-S194. doi:110.37765/ajmc.2023.89417
  13. Desai NR, Clark KAA. Defining a path toward improved heart failure care. Am J Manag Care. 2023;29:S195-S200.doi:10.37765/ajmc.2023.89418
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