Background 

While significant medical strides have been made in reducing cardiovascular mortality and extending life, the number of people experiencing Heart Failure (HF) now exceeds 6.2 million Americans and projections indicate that the prevalence of HF will increase 46% by 2030 to 8 million people diagnosed.1 Current estimates are that 1 in 5 adults will experience HF.2 Most HF is the consequence of the acceleration of cardiovascular aging by known risk factors of hypertension, obesity, type 2 diabetes mellitus, and coronary artery disease. Additionally, certain comorbidities such as atrial fibrillation, anemia, depression, kidney disease, pulmonary disease, and sleep disordered breathing, and social and economic determinants of health contribute to HF development and progression. Sadly, while many may not know it, having these risk factors (but no structural heart disease) is a diagnosis of Stage A HF3.

In the US, our medical model focuses on the treatment of disease. Despite years of public health education and over 30 years of Healthy People targeted goals by the government and leading population health experts, we remain a nation of risk with a medical model that spends most of its resources on the treatment and not prevention of disease. While the analysis is ongoing, a preliminary evaluation reveals that as a populous, we have made little progress toward meeting the established Healthy People 2020 goals that have the most bearing on the development of HF.4 Four key indicators demonstrate little to no improvement:

• Blood pressure control has only increased from 43.7% to 48.9%, with the majority of hypertension still uncontrolled;
• Persons with diagnosed diabetes whose A1c value is >9 percent (age adjusted, percent, 18+ years) has risen from 17.9% to 21.0%;
• Obesity amongst adults and children continues to rise; and
• Tobacco smoking in adolescents has not significantly decreased.
A few positives are noted with:
• Adult cigarette smoking has decreased to 18%; and
• Adults meeting aerobic physical activity and muscle strengthening Federal guidelines had increased to 20% of the population.

Goal: Given that a staggering 80% of cardiovascular disease (including HF) is believed to be preventable (https://www.heart.org/en/get-involved/advocate/federal-priorities/cdc-prevention-programs), AAHFN is tackling HF prevention in 2021 with an aggressive, multifaceted approach to raising awareness and developing actionable approaches to decreasing HF. Our theme for this initiative is Embrace Heart Failure Prevention. This year, we are rolling out multiple educational opportunities, patient education materials, publications, and a personalized call for you to Embrace HF Prevention. None of us is immune and as the direct healthcare provider with the most personal ability to model HF prevention, we are calling on you to walk the talk. All of us have healthy habits we can adopt, so read the articles and join the webinars coming your way not just to educate your patients, but also to make actionable changes in your own life.

References

1. Virani SS, Alonso A, Benjamin EJ, et al. Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-e596.
2. Horwich TB, Fonarow GC. Prevention of Heart Failure. JAMA cardiology. 2017;2(1):116.
3. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240-e327.
4.Healthy People 2020 Leading Health Indicators: Progress Update. In: Services UDoHaH, edMarch 2014.