Congestive Heart Failure Disease

Congestive Heart Failure (CHF) in the Community: Epidemiology and Clinical Understandings

Cardiovascular disease continues to impact more than half a billion people worldwide, and according to NIH in 2021, they were responsible for 20.5 million deaths, or about a third of all fatalities worldwide and an increase from the predicted 121 million CVD deaths.

About 25 years ago, heart failure syndrome was originally identified as an epidemic in the making. Today, the overall number of heart failure patients is still rising as a result of an aging and growing population.

The ICC-National Heart Failure Registry stated that heart failure is the most frequent cardiac reason for hospitalization, affecting 1% of the general population yearly, or 8–10 million individuals. When only the 65–79 age group is considered, when heart failure-related hospitalization is 5–10%, the 1% average for the general population seems different. Hospitalization rates for older adults over 80 are much higher (10–20%).

In India, the national heart attack mortality rate is between 20 and 30 percent (120,000 to 200,000 deaths), compared to 4 to 5 percent in wealthy nations.

The ~1% average in the general population looks different when only the 65-79 age group is considered whereas heart failure-related hospitalization is ~5-10%. Hospitalization rates are much higher (~10–20%) for elderly people above 80 years of age.

Furthermore, according to the research of the JACC Journal Organization Heart failure (HF) is a significant contributor to the morbidity and mortality of cardiovascular disease. In the United States, HF is believed to affect 6.2 million adults, and it is anticipated that the number will rise by 46% between 2012 and 2030, reaching >8 million people under the age of 18.1 In addition to the clinical effects of HF, the economic cost is projected to be $30.7 billion annually in the US.

Congestive heart failure (CHF), commonly known as heart failure (HF), is a disorder that occurs when the heart cannot pump enough blood to meet the body's requirements. If the heart cannot pump enough blood, this occurs. It also occurs if the heart is impotent to impel blood efficiently. The phrase "heart failure" does not necessarily imply that the heart has stopped.

Classification of CHF

Heart failure is classified on the basis of various factors.

It was additionally proposed to re-classify HF according to left ventricular ejection fraction (LVEF), as follows:

• Symptomatic heart failure with a decreased ejection fraction (HFrEF) and an LVEF below 40%
• Heart failure (HF) with slightly reduced ejection fraction (HFmrEF) - symptomatic HF with LVEF 41-49% (formerly referred to as heart failure with mid-range ejection fraction)
• HFpEF, or symptomatic HF with preserved ejection fraction (LVEF 50%)
• HF with improved ejection fraction (HFimpEF) is a novel categorization that is clearly defined as symptomatic HF with a baseline LVEF of less than 40%, a rise of less than 10% from baseline LVEF, and a second measurement of LVEF more than 40%.

According to NIH, although it can affect both sides of the heart, heart failure often only affects the left or right side. Accordingly, doctors distinguish between three types of heart failure:

• Left-side Heart failure: Occurs when the left ventricle is unable to adequately pump blood throughout the body. The outcome is an accumulation of blood in the pulmonary veins, the blood arteries that carry blood out of the lungs. This leads to coughing, breathing problems, or shortness of breath, particularly during strenuous exercise. Left-sided heart failure is the most common type of the condition.
• Right-side Heart failure: Occurs when the right ventricle is unable to adequately pump blood to the lungs. The blood arteries that transport blood from the organs and tissue back to the heart become blocked with blood as a result. The veins' elevated internal pressure causes fluid to leak into the nearby tissue. As a result, fluid accumulates in the legs, or less frequently in the genital region, organs, or abdomen (belly).
• Biventricular heart failure: Both the left and right sides of the heart are damaged by biventricular heart failure. Shortness of breath and a fluid build-up are common signs of both left- and right-sided heart failure in this situation.

Stages of Heart Failure

For a better understanding of the progress of HF researchers have identified four stages of heart failure:

• Stage A (At risk for HF): those who are susceptible to heart failure but do not yet exhibit any indications of structural or functional heart disease Hypertension, coronary artery disease, diabetes, obesity, exposure to cardiotoxic substances, genetic variations for cardiomyopathy, and family history of cardiomyopathy are risk factors for those who are at this stage
• Stage B (Pre heart failure): people who have structural heart disease, elevated heart filling pressures, or other risk factors but no current or past symptoms of heart failure
• Stage C (Peoples with symptomatic HF): individuals who currently or previously have heart failure symptoms
• Stage D (Advanced heart failure): Heart failure patients who experience symptoms that interfere with daily activities or necessitate frequent hospitalizations

Causes

• Coronary artery disease- This happens when the blood vessels that feed the heart muscle with oxygen and nutrients shrink, making the heart have to work harder to pump blood. Coronary artery disease eventually has the potential to damage the heart muscle and impair its capacity to pump blood.
• Congenital heart defects: Heart structural issues that exist from conception.
• Heart failure can result from diabetes complications.
• Infection: Heart failure can result from an earlier infection such as endocarditis, myocarditis, or rheumatic fever.
• Arrhythmias: An irregular heartbeat makes it more difficult for the heart to pump blood efficiently.
• Chronic obstructive pulmonary disease (COPD), emphysema, and pulmonary embolism are a few examples of lung conditions. Low oxygen levels are frequently caused by lung problems. Low oxygen levels might strain the heart more than usual, weakening it and perhaps resulting in heart failure.
• Cardiomyopathy is a disorder that impairs the heart's effectiveness in pumping blood. Cardiomyopathy can be brought on by a number of illnesses, such as sarcoidosis and amyloidosis.

Signs & Symptoms

 “The enigma with heart disease is that the earliest sign is frequently lethal.”

In heart failure, the heart can't supply enough blood to meet the body's needs. Symptoms develop slowly. Sometimes, heart failure symptoms start suddenly. People with CHF experience breathlessness that occurs either while moving or, while still. If the patient doesn't get up and move around, it might become really difficult to breathe at night when it suddenly appears, they feel weakness and drowsiness in everyday activity because the heart is not able to pump the blood according to the needs of body tissue. Swelling Legs, Belly-area, ankles, and feet, an irregular or rapid heartbeat. are also one of the signs of CHF.

It is more difficult for the stomach to absorb nutrients from food when blood flow is reduced, which may result in weight loss or vomiting and a loss of appetite. Increased weight results from extra fluid retention. Sudden weight gain or loss is a sign that you have heart failure or that it is progressing.

Diagnostic Analysis

Due to numerous research initiatives that are creating precise and accurate diagnostic methodologies and tests, the global market for heart failure diagnostics is expanding along with the burden of death from heart failure. The following are the main diagnostic categories that have a substantial impact on the market, based on a number of variables such as a patient's symptoms, medical history, and the development of diagnostic technology.

Physical Examination

Physical examination is the first step in diagnosing HF. Here medical professionals ask for the patient's medical history, list of medications, and symptoms, and measure heart rate and weight. It also involves examination of swelling in the feet and ankles, as well as in the abdomen, and assessing cognitive state.

Blood Test

The blood test is conducted to assess overall health and the level of various body fluids such as Sodium and potassium levels (electrolytes) and creatinine, which helps measure how well the kidneys are working. It also measures B-type natriuretic peptide (BNP), a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure.

Imaging Test

Other tests demonstrate how well the heart is functioning or provide images of the heart and its surroundings:

• Electrocardiogram (ECG/EKG): An ECG employs tiny sensors to measure electrical impulses, rhythm, and heart rate (how quickly the heart beats). The Omron Complete ECG+BP Device is a dual-function health monitoring device that can measure both blood pressure and ECG recording. 
• Cardiac X-ray: An X-ray of the chest shows the heart, lungs, and surrounding organs. It reveals if the heart muscle is enlarged or if you have fluid in the lungs as a result of heart failure. High-frequency X-ray machines from Allenger’s MARS 40-80 KW line are designed specifically for all general radiography and fluoroscopy applications, and prices range from $100 to $2000, depending on the model.
• Echocardiogram (Echo): Sound waves are used in echocardiography to produce images of the heart. It assesses the ejection fraction and reveals how thick the heart muscle has become. EchoPAC™ machine provided by GE Healthcare is most widely used in the diagnosis of congestive heart failure. It provides accurate measurement and diagnosis using 2D &3D images.
• Cardiac MRI: An MRI is a sophisticated imaging procedure that captures images of the heart and its surroundings. It helps evaluate how well the heart works, how big it is, and whether the heart muscle has changed. Doctors could utilize a cardiac MRI to find the root of the heart failure. The INUMAC, the strongest MRI scanner in the world, costs $270 million and the system is capable of producing 11.75 Tesla, which is powerful enough to lift 60 tons.
• Coronary angiogram: This examination aids in identifying cardiac artery blockages. The medical professional places a catheter—a lengthy, thin, flexible tube—into a blood vessel, typically in the wrist or groin. Then it is led to the heart. The catheter allows the dye to enter the heart's arteries. The dye makes the arteries more visible in X-ray and video images.
• Myocardial biopsy: A medical professional performs this test by removing extremely minute sections of the heart muscle for analysis. This examination is carried out to identify certain heart failure-causing cardiac muscle illnesses.

Diagnostic Market Players

Diagnostic Products

Treatment Analysis

Drugs/Medicine-

• The amount of blood that the heart must pump is reduced by medications that flush out excess sodium and water from the body, such as diuretics and Aldosterone Antagonists (such as Spironolactone). Extremely high doses of diuretics increase heart failure symptoms, lower blood pressure, and kidney illness. Aldosterone antagonists can cause renal damage and elevated potassium levels as side effects.
• Medications that relax blood arteries hence the heart pumps blood more easily. Examples include angiotensin receptor blockers (ARBs) and ACE inhibitors. Cough, low blood pressure, and temporarily impaired renal function are examples of potential adverse effects.
• Hydralazine And Nitrates: together diminish afterload, while nitrates also lower preload. The 2013 ACCF/AHA guidelines state that when NYHA class III-IV HF patients get optimal medical therapy (OMT) with ACEi and beta-blockers, there is a Class IA indication that lowers mortality and morbidity between African Americans through HFrEF.
• Digoxin, class IIA, level B of evidence, reduces HFrEF hospitalization but does not increase survival. Digoxin should only be used with caution in women who are experiencing symptoms of heart failure since some research suggests that it increases mortality in women but not in men.
• Statins with Aspirin for ischemic heart failure.
• Sodium-glucose cotransporter 2 inhibitors: According to the DAPA-HF Trial, dapagliflozin (versus no additional drug therapy) (grade 1 B) should be added to optimal medical therapy (OMT) and device therapy in HFrEF patients with increased levels of BNP and persistent signs. This recommendation applies to patients without diabetes as well.[45] Patients with symptomatic hypotension, SBP ≤ 95 mmHg, and eGFR less than 30 ml per minute per 1.73 m are contraindicated.

Surgical and other process-

To address the issue that caused heart failure, surgery or other procedures involving the implantation of a cardiac device are advised.

Heart failure surgery or other procedures might involve:

• Coronary Bypass surgery: If badly blocked arteries are the root cause of heart failure, surgery is necessary. During the procedure, a healthy blood vessel is removed from the leg, arm, or chest and connected below and above the heart's obstructed arteries. The new route enhances the stream of blood to the heart. Despite the fact that CABG has certain risks, it continues to be one of the best therapies for congestive heart failure (CHF), and around 200,000 people undergo CABG surgery annually in the USA, making it one of the most popular heart procedures.
• Implantable cardioverter-defibrillator (ICD): For the prevention of heart failure problems, an ICD is employed. It isn't a stand-alone remedy for heart failure. An ICD is a pacemaker-like gadget. With cables running through veins and into the heart, it is implanted beneath the skin of the chest.
• The heartbeat is monitored by the ICD: The ICD tries to correct the beat if the heart begins to beat at a risky rhythm. The apparatus shocks the heart back into a regular rhythm if it stops. Additionally, an ICD acts as a pacemaker to quicken a sluggish heartbeat.
• Heart valve repair or replacement: The doctor advises fixing or replacing the heart valve if the condition leads to heart failure. Heart valve repair comes in a variety of forms. The kind is dependent on what caused the heart valve issue. Open-heart surgery or minimally invasive surgery can both be used to repair or replace a heart valve.
• Cardiac resynchronization therapy (CRT): CRT, also known as biventricular pacing, is a method of treating heart failure in persons whose lower heart chambers don't pump in unison. The lower heart chambers get electrical signals from a device. The signals instruct the chambers to compress more intentionally. This enhances the heart's ability to pump blood out. CRT is compatible with an ICD. A biventricular pacemaker is used in cardiac resynchronization therapy to help your ventricles contract together. The purpose of an implanted cardioverter-defibrillator (ICD) is to restore a rapid rhythm to normal. Patients with ventricular fibrillation and tachycardia benefit from it. To address all of these problems, many people could require a biventricular pacemaker combined with an ICD.
• Ventricular assist device (VAD): A VAD aids in the movement of blood from the lower heart chambers to the rest of the body. A mechanical circulatory support device is another name for it. A VAD is implanted in either the lower left or lower right chambers of the heart, but it is typically done in the lower left.
• Heart Transplant: Surgery or medications are unable to help some people when their heart failure is so severe. It may be necessary for certain patients to have a healthy donor heart implanted in place of their own. Not everyone needs a heart transplant as a therapy option. If the surgery might be secure and advantageous for you, it is determined by a group of medical professionals at a transplant center.

Treatment Market Players

Regulatory Framework

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Numerous trials have been conducted particularly to assess their function in HF in patients with and without a diabetes diagnosis, and more are currently being developed. On May 26, 2023, Sotagliflozin became the third SGLT2 inhibitor in its class to be authorized for the treatment of HF across the range of left ventricular ejection fraction (LVEF) by the U.S. Food and Drug Administration (FDA).

Furthermore, under section 19A, TGA approved Captopril 25mg/5mL Sugar-free oral solution (Syrimed) of Reach Pharmaceuticals Pty Ltd for the treatment of HF. TGA has given the indication that the medication captopril is prescribed to treat heart failure. Captopril should be given along with a diuretic to patients who are symptomatic.

In December 2022, Boehringer Ingelheim Pty Ltd got the approval for the production of a generic product named Jardiance which has the active ingredient Empagliflozin. Adults with symptomatic heart failure who do not have a reduced left ventricular ejection fraction may benefit from using Jardiance in addition to normal treatment.

However, a new product dapagliflozin (FORXIGA) has also been launched by AstraZeneca Pty Ltd for the treatment of heart failure. It has the active pharmaceutical ingredient dapagliflozin propanediol monohydrate.

Market Trends

Treatment for heart failure is increasingly using implanted devices like ICDs and biventricular pacemakers. A significant increase in the use of ICDs has been supported by recent research as a means of reducing the death rate (sudden cardiac) of individuals with HD.

Some studies have reported that the majority of people adapt well to implanted devices. It revealed a strong correlation between gender, device type, monthly income, and duration. Regarding psychological and emotional care, special attention must be paid to patients who are female and divorced.

The importance of new technology developments and studies on pertinent medications cannot be emphasized. This technology increases the effectiveness of currently accessible medications and discovers fresh therapeutic targets for potential future research.

Clinical Trial Assessment

Conclusion

Heart failure is typically a chronic ailment that needs constant care to avoid consequences. If heart failure is not treated, a life-threatening consequence results from the heart's extreme weakening.

It's crucial to practice lifelong prevention for the health of the heart. Always get in touch with a doctor if suddenly have any new or strange symptoms that could point to a cardiac condition. Since heart failure usually lasts a long time, symptoms will most likely get worse with time. Surgery and medication help with symptom relief, but if you have severe heart failure, these therapies might not be effective. Heart failure occasionally endangers life.

DLI's services make it easier for market players to conduct clinical studies for new drugs and treatments. It also helps with other tasks including patient recruiting and regulatory compliance. DLI also gives industry participants comprehensive information about rivals in the market, market expansion, and new laws and regulations worldwide.