title: A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms.
abstract: Heart failure (HF) is commonly described according to the severity of symptoms, using the New York Heart Association (NYHA) classification, and the assessment of ventricular function, by measuring the left ventricular ejection fraction (LVEF). It is important to acknowledge, however, that the severity of symptoms does not systematically correlate with the level of ventricular systolic dysfunction. Patients with no or only mild symptoms are still at high risk of HF-related morbidity and mortality. The objective of this review was to summarize the prevalence, characteristics, and treatment of patients with chronic HF and mild or no symptoms and to review epidemiological data from three recent registries conducted in Europe. From a clinical practice perspective, patients with a reduced ejection fraction who have only mild symptoms appear to represent a group of patients for whom the provision of adequate medical care is yet to be optimized. While prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers appears to be consistently high, the use of mineralocorticoid receptor antagonists is more variable and does not appear to be in accordance with the latest clinical guidelines. As approximately half of patients with HF and a reduced LVEF have NYHA class II symptoms, significant reductions in morbidity and mortality could be achieved by more comprehensive treatment of this population.
authors.affiliation: Department of Cardiology, University Hospital of Caen Basse-Normandie, Caen, France, beygui-f@chu-caen.fr.
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.forename: Ulrich
authors.initials: U
authors.lastname: Tebbe
authors.forename: Josep
authors.initials: J
authors.lastname: Comin-Colet
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.forename: Eva
authors.initials: E
authors.lastname: Turgonyi
authors.forename: Katharina
authors.initials: K
authors.lastname: Lins
authors.forename: Lynda
authors.initials: L
authors.lastname: Imekraz
authors.forename: Trinidad
authors.initials: T
authors.lastname: de Frutos
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D002317:Cardiovascular Agents / Q000145:classification / Q000494:pharmacology; D019468:Disease Management; D005060:Europe / Q000453:epidemiology; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D018579:Patient Selection; D015995:Prevalence; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D002317:Cardiovascular Agents