Transforming cardiovascular care and the burden of heart failure

At AstraZeneca, we believe we play a pivotal role in advancing the understanding of heart failure (HF) and driving better patient outcomes. In partnership with healthcare systems around the world, we aim to improve the lives of HF patients and halve hospitalisation for HF and mortality rates by 2030. Through global collaborative initiatives, our ambition is to reduce the burden of HF on patients, healthcare systems and society.

HF is a complex and progressive disease

HF is a long-term condition with acute exacerbations that worsens over time as the heart becomes too weak or stiff to pump enough blood to meet the body’s needs, leading to debilitating physical and emotional symptoms.⁴ Patients living with HF often experience shortness of breath, fatigue, swelling in legs, sleep disturbances, chest pain and depression.^4,5 These symptoms significantly impair daily activities, resulting in compromised quality of life and high hospitalisation and mortality rates.^4,6-8

Despite the progressive nature of HF, initiating evidence-based, guideline-directed medical therapy (GDMT) regimens have been shown to significantly reduce the risk of cardiovascular death and HF hospitalisation.^9,10 For patients with HF with reduced ejection fraction (HFrEF), early and comprehensive implementation of GDMT can modify disease progression, improve symptoms, and substantially lower mortality and rehospitalisation rates.^9,10

Beyond the impact of HF on patients, it also imposes a significant economic burden on healthcare systems. As of 2020, the global cost of HF was estimated to be $346.17,¹¹ with projections indicating a staggering 127% increase in HF costs in the US alone by 2030.¹² Hospitalisations, responsible for up to 87% of expenses, are a major driver of healthcare costs associated with HF.¹³ In 2021, the estimated economic burden of HF was $284.17 billion across 179 countries¹⁴ HF has a high 30-day hospitalisation readmission rate, with approximately 25% of HF patients readmitted within 30 days after discharge*.¹⁵

HF is often underdiagnosed with high hospitalisation and mortality rates

Studies have shown symptoms of HF can manifest up to five years before an official diagnosis, affecting over 40%** of patients.¹⁶ A significant portion of HF cases are identified in a hospital setting, with 38% of US cases diagnosed in acute settings.¹⁷ But around 46%* of patients with HF previously reported symptoms to their primary care physicians prior to diagnosis in acute care settings.¹⁷ The REVOLUTION HF population study¹⁸*** showed that 30% of ambulatory patients presenting with signs and/or symptoms of HF and high levels (>300 ng/L) of N-terminal pro-B-type natriuretic peptide (NTproBNP) end up with an official diagnosis within one year.

The consequences of delayed HF diagnosis can lead to significantly poor clinical outcomes. Delayed detection often results in more severe HF at the time of diagnosis, hindering access to preventive medications and leading to an increase in CV events and hospitalisations.¹⁹ Patients that are hospitalised for HF are at a higher risk of death and other adverse outcomes during their stay and post-discharge period.²⁰ Global mortality in HF patients post-hospitalisation is high—7.6% at 30 days and 23.3% at one year.²¹ Vulnerability associated with the early post-discharge period is why contemporary guidelines emphasise the importance of GDMT optimisation prior to hospital discharge and early follow-up for continued treatment titration to reduce the risk of rehospitalisation and improve survival.^9,10 For patients with HFrEF, foundational GDMT consists of four core therapy classes: renin–angiotensin system inhibitors, beta blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose co-transporter 2 inhibitors (SGLT2is).^9,10

Despite advancements in HF treatment and prevention, morbidity and mortality rates remain high. Within one year of HF diagnosis, 20-30% of patients pass away.³ Despite its prevalence and impact, public awareness of HF remains relatively low.^1,22

HF GDMT may slow disease progression and help manage comorbidities

Early detection of HF plays a crucial role in preventing poor clinical and patient outcomes.²³ Timely diagnosis allows for early intervention and access to appropriate treatments, which can slow the progression of the disease and improve quality of life.^23,24 Medical guidelines and GDMTs are an important part of the solution as they help provide patient-centric recommendations for clinicians to diagnose and manage patients.^9,10

GDMT recommends four classes of evidence-based therapy that have been shown to reduce HF hospitalisation and mortality: renin–angiotensin system inhibitors (ACE inhibitors, ARBs, or ARNIs), beta blockers, MRAs, and SGLT2is.^9,10 Randomised controlled trials for these therapy classes have demonstrated that these therapies can reduce the risk of CV death and worsening HF events—treatment with renin–angiotensin system inhibitors, beta blockers, and SGLT2is, for example, have been shown to reduce incidence of death from CV causes or worsening HF by 13-35%.^25,26

For HF care teams, parameters for care include the European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure,¹⁰ the American College of Cardiology/American Heart Association/Heart Failure Society of America Guidelines for the Management of Heart Failure,⁹ and the latest clinical consensus on the use of left ventricular ejection fraction in the diagnosis and management of heart failure from Heart Failure Association (HFA) of the ESC, the Heart Failure Society of America (HFSA), and the Japanese Heart Failure Society (JHFS), among others.²⁶ These guidelines provide insights into the distinct types of HF, ways to approach the disease, and recommendations for early diagnosis and intervention.^9,10

Outcomes data from randomised HF trials^27-29 further underscore GDMT guidance^9,10 that HFrEF patients should receive foundational medications as soon as possible following diagnosis to improve outcomes. Guidelines further recommend initiation and optimisation of GDMT as early as clinically feasible, including during hospitalisation for HFrEF once patients are haemodynamically stable.^9,10 Early in-hospital initiation allows clinicians to monitor tolerability, initiate titration toward target doses, and reduce exposure to the high-risk post-discharge period, potentially mitigating the increased risk of mortality and readmission during this time.^9,10

Growing evidence shows that following these guideline-recommended treatment strategies for hospitalized HF patients can significantly reduce re-hospitalisations and death,^30,31 yet use of GDMT is still underutilised.³² Despite clear evidence and guideline recommendations, studies consistently demonstrate variability in initiation, continuation, and dose optimisation of foundational therapies in routine clinical practice.^9,10,33 Incomplete implementation of GDMT, delays in therapy escalation, and therapeutic inertia contribute to preventable hospitalisations and adverse outcomes, underscoring the need for systematic approaches to improve adherence to evidence-based care.^9,10 Furthermore, emerging consensus from the HFA of the ESC, HFSA, and JHFS recommends personalising HF management strategies, which include broadening diagnostic criteria and proposing initiation of HF therapies without delay in appropriate patients, including suspected new-onset presentations of HF whether or not a patient has received an echo.²⁶

The presence of comorbidities adds complexity to HF management. Many HF patients have other concurrent medical conditions such as high blood pressure, diabetes or CKD.^34,35 These comorbidities can further impact the clinical outcomes and treatment approaches for HF patients. It is crucial for healthcare providers (HCPs) to consider these additional conditions when developing comprehensive management plans for patients with HF. By leveraging guidelines and GDMT to address both HF and comorbidities, healthcare professionals can optimise treatment strategies and improve patient outcomes.^9,10

Who is at risk for HF?

HF can vary in cause and area of the heart affected, but a person is at increased risk if they have a history of coronary artery disease, heart attacks, chronic kidney disease (CKD), diabetes or hypertension.^36-38

Lifestyle behaviours can also increase the risk of HF, especially for people with one of the pre-existing conditions. These behaviours include smoking tobacco, eating foods high in fat, cholesterol, and sodium, and physical inactivity.^9,23

Early identification of individuals at increased risk for HF creates an important opportunity for proactive cardiovascular evaluation, earlier detection of cardiac abnormalities, and timely initiation of GDMT when HF develops.^9,10 Clinical guidelines emphasize that prompt initiation of foundational GDMT in eligible patients can potentially prevent HF or reduce the risk of progression, hospitalisation, and premature death.^9,10 Recognizing at-risk populations, particularly those with coronary artery disease, CKD, diabetes, or hypertension allows healthcare professionals to intervene earlier and optimise long-term outcomes through evidence-based treatment strategies.^9,10

Gap between guidelines and real-world practices

Although GDMT is recognised as standard of care for HFrEF, real-world data reveal that a substantial proportion of eligible patients do not receive all recommended foundational therapies or are not titrated to target doses established in clinical trials. Data from the CHAMP-HF registry shows that only 73%, 66%, and 33% of eligible HFrEF patients receive renin–angiotensin system inhibitors, beta blockers, and MRAs, respectively.⁹ Claims data has demonstrated that roughly 42% of patients are not prescribed any GDMT within 30 days of hospitalisation, and 45% are prescribed either no oral GDMT or only monotherapy within 1 year of hospitalisation.⁹ Furthermore, very few patients with HFrEF actually receive the target doses of GDMT—most HFrEF patients do not make changes to their oral GDMT over the 12 months post-hospitalisation despite being discharged on suboptimal doses.⁹

Closing this implementation gap represents a critical opportunity to reduce HF-related hospitalisations and mortality at a population level. Systematic optimisation of discharge protocols, multidisciplinary HF management programmes, and structured follow-up have been identified as key strategies to improve adherence to guideline-directed care.

Our commitment to people living with HF

We consider ourselves a central part of HF healthcare and are working with the CV community to transform the delivery of HF care. Our ambitious goal is to aim improve the lives of HF patients and halve hospitalisations for HF and mortality rates by 2030.

To realise this ambition, we launched the Accelerate Change Together (ACT) on HF programme to drive comprehensive HF change across the healthcare ecosystem. Through ACT on HF, we aim to elevate HF as a healthcare priority and highlight the development of national strategies. We’re also working to support HCPs to enhance prevention and diagnosis capabilities, and partner with them to improve HF management and ensure all HF patients receive optimal and integrated care.

Increasing awareness and education on HF and GDMT are particularly important components of ACT on HF, as early detection and intervention can help patients receive optimal guideline-directed care.³⁹ Since the launch of ACT on HF in 2020, we estimate we have contributed to raising HF awareness among more than 80 million people and supported more than 600,000 HCPs receiving HF education.

Projects to encourage urgency of early HF screening, diagnosis and treatment intervention

To drive change in HF, we are working together with global, regional and local partners. Through our collaborative efforts, we aim to implement innovative approaches, leverage the latest technologies, and undertake large-scale initiatives to improve early diagnosis rates and enhance the lives of individuals affected by HF worldwide.

We are committed to expanding understanding around HF and have generated real-world evidence on:

Patient empowerment is key to HF intervention

In addition to disease awareness, we prioritise patient empowerment and help amplify their voices through publications in peer-reviewed journals. As part of our ACT on HF initiative, we supported a co-authored article with a cardiologist to encourage closer collaboration between HCPs and their patients with HF to highlight challenges and opportunities of people living with HF.⁴⁰

Through our collaborations, we actively support initiatives that encourage individuals living with HF to self-manage their care. These initiatives include providing patients with the resources, tools and educational materials needed to effectively manage their health including connecting them with materials such as the ESC patient guidelines for self-managing HF.¹⁰

Patient education and adherence to prescribed GDMT are essential components of effective HF management. Evidence suggests that structured self-care education, medication adherence support, and early reporting of symptom worsening can reduce hospitalisations and improve survival.¹⁰ Empowering patients to understand their treatment plan and engage actively in follow-up care can strengthen the effectiveness of guideline-directed therapy.

HF requires immediate collaborative action

Addressing any public health problem requires partnering with global, regional and national leaders. Through collaborating with policymakers, we can increase awareness about the consequences of HF and drive change and innovation at multiple levels. This includes shifting earlier HF diagnosis to the community care setting, further alignment on unified global standards to follow the latest expert GDMT recommendations, initiating early treatment immediately following HF diagnosis, and developing integrated best-practice models of HF care. Alignment on global standards for early initiation and optimisation of GDMT across primary care, hospital settings, and specialty care is essential to reducing preventable HF hospitalisations and mortality. Embedding GDMT optimisation into discharge pathways, standardising early follow-up within 1–2 weeks post-discharge, and implementing multidisciplinary HF programmes have been shown to improve adherence to evidence-based therapy and enhance patient outcomes.^9,10

Through joint efforts involving the entire community, we can make a profound difference and forge a future with improved HF outcomes for all. The complexities of HF require the entire CV community to transform HF management and care to reduce hospitalisations and improve outcomes.  We remain steadfast in our commitment to transforming HF and achieving sustainable change for patients all over the world.

*Data refers to a US population
**Data refers to a UK population
***Data refers to a Swedish population

Veeva ID: Z4-76267
Date of preparation: August 2025