Heart: ‘epidemic of heart failure’ affecting 800,000: the treatment works, but it must be available to everyone

Heart failure remains a veritable epidemic and one of the main public health challenges in Italia, affecting around 800,000 people. It is the leading cause of hospital admission worldwide among patients aged over 65. The most recent epidemiological data paint a picture of the condition as a genuine health and social emergency, which is rising sharply both in Italia and internationally.

Despite advances in research, the prognosis remains poor; in Italia, it accounts for more than 130,000 hospital admissions a year, placing it at the top of the list of hospitalisations that could potentially be ‘avoided’ through better community-based care. The 5-year mortality rate is comparable to or worse than that of many cancers.

Over the last few years, new pharmacological and interventional treatments have been introduced. In clinical trials, some of these therapies have been shown to significantly improve patients’ prognosis; however, in the real world, there are still challenges to their widespread adoption. Heart failure is often associated with other conditions that can worsen the prognosis and complicate the management of these patients. The data emerging from the Bring-Up 3 Scompenso observational study, conducted by ANMCO (the National Association of Hospital Cardiologists) and involving around 180 centres across the country, provide a vital epidemiological snapshot and are a source of great pride for the ANMCO hospital research network. The registry highlights how the timely introduction of quadruple drug therapy — the so-called ‘four pillars of heart failure’ — is now well established in 65 per cent of the patients followed. The widespread adoption of these new standards of care, particularly when initiated early, has led to a drastic reduction in mortality associated with this condition over the years. However, despite this extraordinary clinical success, the study reminds us that around 1 in 5 patients is readmitted within a year. This figure clearly tells us that haemodynamic stability does not end with discharge from hospital: our top priority now is to overcome residual clinical inertia, maximise dose titration and optimise community follow-up during the first 30 days, thereby transforming the effectiveness of the Bring-Up protocol into a concrete shield against early readmissions.

 Optimising routes

The management of heart failure currently faces a crucial challenge: ensuring that optimal treatment is made widely available and accessible throughout the country. It is not enough simply to have effective treatments; it is essential that these treatments reach every single patient, thereby reducing hospital admissions and improving quality of life. The possibility of optimising the treatment pathway to the fullest extent exists and is very real. ANMCO is at the forefront of this mission, promoting standards of excellence on a widespread basis through innovative research protocols, strategic consensus documents, scientific conferences and continuing professional development programmes for cardiologists. Only by combining widespread dissemination with precise medical training can we translate scientific evidence into improved health outcomes for the public. Our strategic objective is to leave no one behind. The future of cardiology is not measured solely in terms of scientific innovations, but also by the practical ability to apply them every day, consistently and comprehensively across the whole country.