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Heart Failure - Dr. Elizabeth Ofili
Heart failure poses significant health and financial burdens on patients and on the society as a whole. The major cost-driver in heart failure is the high incidence of hospitalizations. Patients with heart failure are at high risk for hospitalizations and mortality, which has been estimated to be about 50% at five years. Sudden cardiac arrest is the primary mode of death in mild to moderate heart failure, and occurs at 6 to 9 times the rate of the general population. Several guidelines have been developed on the management of heart failure, including those established by the American College of Cardiology and the American Heart Association. Nevertheless, marked gaps and variations exist in the quality of care for heart failure; thus, many opportunities exist to improve care for patients with heart failure. Despite overwhelming clinical-trial evidence, expert opinion, national guidelines, and a vast array of educational conferences, evidence-based, life-saving drug and device therapies continue to be underutilized. Recommendations for medication and device therapies are rapidly evolving, therapy is more complex, and collaboration among physicians (primary care physicians, cardiologists, heart-failure specialists, and electrophysiologists) can be challenging. New approaches to improving the use of proven, guideline-recommended, life-saving therapies are clearly needed.
Dr. Ofili also described gaps in present knowledge concerning long-term care of heart failure. Specifically, more long-term data are needed for the following: physicians’ use of evidence-based medications; patient adherence to prescribed medications; how comorbidities affect care; use of adequate dietary counseling and patient adherence to dietary regimen; early care with escalating symptoms; adequacy of discharge planning, outpatient follow-up, and outpatient monitoring; patient social support systems; patient and care-giver needs, and disparities in the care of minorities. She emphasized the need for heart-failure surveillance, particularly one in which outpatient heart failure as well as ethnic disparities in care can be clearly assessed.