Dr. Morris-Simon is a Senior Medical Director, U.S. Medical Affairs at Bayer.
Heart failure (HF) care is complex. Most people with HF are balancing multiple comorbidities — such as, diabetes, hypertension, obesity, and chronic kidney disease (CKD) — and even with guideline-directed medical treatments, HF hospitalization and cardiovascular (CV) mortality remain high.1 In the U.S., HF is responsible for approximately 1.2 million hospitalizations and 400,000 deaths each year.2
Currently, there are a number of treatments for HF with reduced ejection fraction (HFrEF) with evidence-based guideline recommendations that demonstrate improvement in CV mortality and HF hospitalizations.3 Conversely, there are fewer therapies available for HF with preserved ejection fraction (HFpEF) and HF with mildly reduced ejection fraction (HFmrEF), with most guideline recommendations focusing on symptom management and reducing HF hospitalizations.3 The unmet need is substantial, given that patients with HFpEF and HFmrEF collectively account for the majority of those living with HF.2 As such, clinicians may need additional information on how to effectively diagnose and manage these patients as they frequently present with multiple comorbidities that can complicate management strategies.4
To improve disease management, there is a growing emphasis on developing integrated care models and tools like personalized treatment plans and patient education programs. As such, HF care is ideally provided by multidisciplinary teams that include cardiologists, advanced practice practitioners, primary care providers, pharmacists, dietitians, and additional specialists.3
HF symptoms can develop gradually over time or appear suddenly, depending on the individual. Common signs include shortness of breath during activity or at rest (particularly while lying down), fatigue, and swelling in the legs, ankles, feet, or abdomen. Some people may experience a persistent cough along with wheezing. Other symptoms include reduced ability to exercise, nausea, loss of appetite, sudden weight gain due to fluid retention, and cognitive changes like difficulty concentrating or decreased alertness. In cases where HF is triggered by a heart attack, chest pain may also be present. When atrial fibrillation is the underlying trigger, patients may experience a rapid, irregular heartbeat, which can occur with or without chest pain or shortness of breath.5
Classification by Ejection Fraction
HF is classified according to the left ventricular ejection fraction (LVEF), which measures how much blood the left ventricle pumps out with each contraction, expressed as a percentage of the amount it takes in with each relaxation.
The determination of LVEF is a fundamental step to guiding evidence-based pharmacological and device-based therapy. The American Heart Association (AHA), in collaboration with the American College of Cardiology (ACC) and the Heart Failure Society of America (HFSA), published comprehensive guidelines in 2022 for managing different types of HF based on the patient’s LVEF.3
Engaging in Collaborative Care Management
Since patients with HF often have multiple comorbidities,1 the use of optimal guideline-directed medical therapy (GDMT) for HF involves the simultaneous use of multiple pharmacotherapies. By targeting different pathophysiological pathways that contribute to the progression of HF, this approach can help reduce patients’ risk of CV mortality and HF-related complications. Safely managing medications necessitates personalized treatment plans, ongoing monitoring, and collaboration between the patient and their care team.4
Given the complexity of HF management and the need for coordinated implementation of GDMT, direct communication among members of the multidisciplinary care team, including cardiologists, nurses, pharmacists, and other specialists, is critical to delivering effective treatment and supporting patient self-care.3
For a complex disease like HF, it’s crucial to educate patients about self-management strategies like monitoring their weight, following dietary guidelines, and adhering to their medication schedule. This comprehensive, evidence-based approach may improve outcomes in patients with HF.3 By prioritizing integrated care approaches that include collaboration among providers, customized treatment plans, and patient education, there may be an opportunity to rethink our approach to treating people with all types of HF.
Dr. Morris-Simon is a board-certified heart failure cardiologist and Senior Medical Director at Bayer in U.S. Medical Affairs. Prior to joining Bayer, she was an Associate Professor of Medicine in the Division of Cardiology at Emory University School of Medicine and served as Director of Heart Failure Research at Emory. She has experience in both clinical trial design and patient recruitment, and her research focused on health disparities in heart failure related to race, ethnicity, and gender.
References
- Desai N, et al. Heart failure with mildly reduced and preserved ejection fraction: A review of disease burden and remaining unmet medical needs within a new treatment landscape. Heart Fail Rev. 2024;29(3):631-662.
- Bozkurt A, et al. Heart failure epidemiology and outcomes statistics: A report of the Heart Failure Society of America. J Card Fail. 2023; Oct;29(10):1412-1451. doi: 10.1016/j.cardfail.2023.07.006.
- Heidenreich P, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023. https://pubmed.ncbi.nlm.nih.gov/35379503/.
- Kapelios CJ, Shahim B, Lund LH, Savarese G. Epidemiology, Clinical Characteristics and Cause-specific Outcomes in Heart Failure with Preserved Ejection Fraction. Card Fail Rev. 2023;9:e14. Published 2023 Nov 17. doi:10.15420/cfr.2023.03.
- Mayo Clinic. Heart Failure Overview. https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142. Accessed March 28, 2025.
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