Rediscovering Heart Failure: The contemporary burden and profile of heart failure in Australia

We undertook a study of the contemporary burden of heart failure to complement a previous report released more than a decade ago. During that time, a combination of population dynamics (an ageing population), an evolving armoury of therapeutics to treat the traditional drivers of heart failure (coronary artery disease and hypertension) and a changing risk factor profile (with more diabetes and obesity than ever before) had the potential to either reduce or increase the impact and burden of heart failure from a whole society perspective.

At the same time, the definition of heart failure has evolved and this has provided an extra dimension to the burden it imposes; even if the therapeutic options for affected individuals with so-called heart failure with preserved ejection fraction or diastolic heart failure is limited.

We would emphasise that estimating the “theoretical” burden of heart failure based on systematic screening of representative samples from whole populations as an accurate picture of the “actual” clinical burden of heart failure based on real-word clinical practice is fraught with danger and uncertainty. Some of the figures in this report only make sense if you accept that a problem is only as big as you can quantify it. In so-called Rumsfeld speak we quantify both the “known-known” and the “known-unknown” aspects of heart failure from a population to clinical burden perspective.

Noting the above caveats, utilising contemporary Australian data (including the Western Australia Linkage data-set and the landmark Canberra Heart Study), we were able to update our estimates and provide, what we would regard as a valid and relatively accurate picture of the contemporary burden imposed by heart failure in Australia from an individual to whole society perspective. We would emphasise that much of this burden remains hidden. However, this hidden burden can be likened to the submerged iceberg that feeds the incident cases of clinical heart failure in our community.