First-of-its-kind tool to close heart failure treatment gap

A new heart failure treatment calculator overcomes a key barrier to evidence-based care, providing personalised predictions of how treatment combinations will affect blood pressure, kidney function and potassium levels.

The free tool is developed by experts at Australia’s George Institute for Global Health and Brigham and Women’s Hospital, a major teaching affiliate of Harvard Medical School using over 38,700 individual patient data. It provides personalised estimates of the potential effects of treatment for patients with heart failure. The research was presented at the recent European Society of Cardiology (ESC) Congress.

“Over the last 30 years, we have seen significant treatment advances for patients with heart failure, but adoption of these therapies has been poor,” said Dr Nelson Wang, Cardiologist and Senior Research Fellow at The George Institute for Global Health. “Fear of adverse effects, particularly low blood pressure, worsening kidney function or high potassium levels are the major reasons clinicians do not start treatment.”

The calculator is designed to address those concerns by estimating how different combinations of heart failure therapies could affect blood pressure, kidney function, measured through estimated glomerular filtration rate (eGFR), and serum potassium. Rather than providing a one-size-fits-all assessment, the tool generates estimates according to individual patient characteristics, including age, sex, body mass index, baseline blood pressure, kidney function, potassium levels and previous hospitalisation for heart failure.

The need for such a tool reflects a persistent gap between the proven benefits of combination therapy and its uptake in clinical practice.

Combination treatment has been shown to provide added benefits in heart failure. Current guidelines recommend a four-pillar approach comprising a beta-blocker, angiotensin receptor blocker–neprilysin inhibitor (ARNI), steroidal mineralocorticoid receptor antagonist (sMRA) and sodium glucose cotransporter 2 inhibitor (SGLT2i) for patients with heart failure with reduced ejection fraction. Together, these therapies can reduce the risk of death from any cause by up to 60%.

Despite this evidence, registry data suggest that only 2% of eligible patients receive the recommended combination treatment.

In the new analysis, researchers found that recommended treatment combinations were associated with modest reductions in blood pressure and early declines in kidney function, as well as small to modest increases in serum potassium levels. Importantly, these changes were accompanied by substantially lower risks of worsening heart failure events. Depending on the treatment combination, the risk was reduced by between 31%-61% compared with standard care.

Heart failure is becoming increasingly common as populations age and more people survive heart attacks, but it remains associated with substantial morbidity, impaired quality of life and a one-year mortality risk of up to 30%.

“By providing a personalised estimate of what to expect when initiating combination therapy, the calculator can reduce uncertainty and give clinicians greater confidence to prescribe these treatments simultaneously, ultimately helping more patients receive therapies that improve long-term outcomes,” explained Dr Wang.

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