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A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms

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Abstract

Heart failure (HF) is commonly described according to the severity of symptoms, using the New York Heart Association (NYHA) classification, and the assessment of ventricular function, by measuring the left ventricular ejection fraction (LVEF). It is important to acknowledge, however, that the severity of symptoms does not systematically correlate with the level of ventricular systolic dysfunction. Patients with no or only mild symptoms are still at high risk of HF-related morbidity and mortality. The objective of this review was to summarize the prevalence, characteristics, and treatment of patients with chronic HF and mild or no symptoms and to review epidemiological data from three recent registries conducted in Europe. From a clinical practice perspective, patients with a reduced ejection fraction who have only mild symptoms appear to represent a group of patients for whom the provision of adequate medical care is yet to be optimized. While prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers appears to be consistently high, the use of mineralocorticoid receptor antagonists is more variable and does not appear to be in accordance with the latest clinical guidelines. As approximately half of patients with HF and a reduced LVEF have NYHA class II symptoms, significant reductions in morbidity and mortality could be achieved by more comprehensive treatment of this population.

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Acknowledgments

The statistical evaluation by the statisticians responsible for VIDA-IC, PAROS, and REFLECT-HF is acknowledged. The preparation of this overview was sponsored by Pfizer.

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Authors and Affiliations

  1. Department of Cardiology, University Hospital of Caen Basse-Normandie, Caen, France

    Farzin Beygui

  2. Cardiology, Heart Failure and Transplant Program, Hospital University Reina Sofia, Cordoba, Spain

    Manuel Anguita

  3. Abteilung für Kardiologie, Angiologie und Intensivmedizin, Klinikum Lippe-Detmold, Detmold, Germany

    Ulrich Tebbe

  4. Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    Josep Comin-Colet

  5. Department of Cardiology A, University Hospital of Toulouse – Rangueil Hospital, Toulouse, France

    Michel Galinier

  6. Institute for Pharmacology and Preventive Medicine, Menzelstrasse 21, 15831, Mahlow, Germany

    Peter Bramlage

  7. Pfizer Ltd., Dorking Rd, Tadworth, KT20 7NS, UK

    Eva Turgonyi & Katharina Lins

  8. Pfizer France, Paris, France

    Lynda Imekraz

  9. Pfizer Spain SLU, Madrid, Spain

    Trinidad de Frutos

  10. Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Saar, Germany

    Michael Böhm

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  1. Farzin Beygui
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  2. Manuel Anguita
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  10. Trinidad de Frutos
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  11. Michael Böhm
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Correspondence to Farzin Beygui.

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Conflict of interest

Farzin Beygui, Manuel Anguita, Ulrich Tebbe, Josep Comin-Colet, Michel Galinier, Peter Bramlage, and Michael Böhm have received research funding from a number of pharmaceutical companies interested in heart failure, including Pfizer. Peter Bramlage was a paid consultant to Pfizer in connection with the development of this manuscript. Eva Turgonyi, Anke M. Strunz, Trinidad de Frutos, Lynda Imekraz, and Katharina Lins are employees of the medical department at Pfizer.

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Beygui, F., Anguita, M., Tebbe, U. et al. A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms. Heart Fail Rev 20, 545–552 (2015). https://doi.org/10.1007/s10741-015-9496-5

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