The ageing population and growing risk factors have made a significant impact on driving up the number of registered heart failure cases. Existing pharmacological strategies are improving the survival rates of acute and early-stage heart failure patients, ironically providing a growing body of patients with progression of the disease to heart failure.

With no new drug therapies addressing advanced heart failure and existing pharmacological strategies failing to compensate for a weakening heart, alternative solutions have to be found. In view of long waiting lists for heart transplantation and the growing lack of donor hearts, significant numbers of patients die while waiting for a heart transplant. But cardiac resynchronization therapy, mechanical circulatory support devices and other alternative technologies have demonstrated promising results, and the continuing rapid technological developments in this area suggest we may only be a decade away from eliminating the reliance on heart transplantation.

The number of sufferers of heart failure is expected to climb to epidemic proportions. Worldwide, heart failure (HF) affects nearly 23 million people. In the United States, HF affects approximately 4.7m persons with approximately 550,000 incidences of HF diagnosed annually. Estimates of the prevalence of symptomatic HF in the general European population are similar to those in the United States and range from 0.4 to two percent of the total population. Existing gold-standard pharmacological strategies are able to provide superior compensation of acute and early-stage heart failure patients, increasing their survival rates without ensuring a full recovery. This results in an increasing long-term shift of such patients into the advanced heart failure group.

In the US, proximally 2,500 heart transplants are carried out each year and research has suggested that up to 100,000 patients have advanced heart disease that would benefit from transplantation. This leads to 30% of patients on the waiting list dying annually.

Cardiac resynchronization therapy (CRT), through multiple randomized clinical trials has demonstrated promising results in terms of both safety and efficacy, improving left ventricular efficiency and, subsequently, improving functional class. However, one of the greatest limitations of this technology is the fact that existing CRT devices, similarly to pharmacological treatment, can only temporarily improve symptoms and to some degree delay the progression of myocardial deterioration. Unfortunately neither can prevent, stop or reverse it.

Although at present we can not completely eliminate the need for heart transplantation, rapid technological developments indicate that we are not that far away from sorting mechanical issues, coagulation control and device-related infections with serious breakthroughs expected within next five to 10 years.

For more information see Stakeholder Opinions: Heart Failure
When drugs do not work