Towards Better Device Management for Heart Failure Dr Anthony Chow Heart Rhythm Congress 2009

Epidemiology of heart failure • Approximately 5 million people in US have heart failure • Europe – Prevalence 3.9% 1 – Annual incidence 1.3 cases per 1000 population age >25y – Rising to 11.6% cases in over 85 years

1

Cowie et al Eur Heart J 1999

Prevalence of heart failure in UK 1,020,000 1,000,000 980,000 960,000 940,000 920,000 900,000 880,000 860,000 840,000 820,000

2006

2009

2012

2015

Year Mortality stats. Office of National statistics UK 2002

Economic burden of heart failure • Commonest cause of hospitalisation US and UK 1 – 78% of HF patients have at least 2 hospital admissions/year 2

• Non-compliance & failure to seek care cause 67% of readmissions • Annual cost of HF in the U.S. is estimated to be between $15-38 billion 3 • Accounts for 1.2 - 2% all health care costs – 60-70% related to hospital admissions

1Havranek

EP, Abraham WT, The Healthcare Economics of Heart Failure 1998; 14:10-18 2 English M and Mastream M. Crit Care Nurse 1995;18:1-6 3 2008 update: AHA Stats Committee and Stroke Stats Subcommittee Circ 2008: 117:e25-146

HF: Rate of death from any cause

1 year mortality: 11.8% (eplerenone), 13.6% (placebo) Pitt et al NEJM 2003;348:1309-21

Heart Failure Mortality Heart failure mortality 100

N= 552 Survival (%)

80 60 40 20 0

1

2

3

4

5

Time from diagnosis (years)

The London Heart Study 2005 BHF data

LVEF and SCD Incidence % SCA Victims

8

7.5%

7 6

5.1%

5 4 2.8%

3 2

1.4%

1 0 0-30%

31-40%

41-50%

>50%

LVEF Vreede-Swagemakers JJ. J Am Coll Cardiol. 1997;30:1500-1505.

MERIT-HF Lancet 1999:353:2001-7

Meta analysis of Secondary prevention Trials (AVID,CASH, CIDS) RRR=28%

RRR=50%

P