Stakeholder Insight: Heart Failure

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Publication Date: 2005-06-02

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During the past two decades, heart failure has emerged as a major chronic disease among the elderly population in the major pharmaceutical markets. The leading cause of hospitalization among patients over the age of 65 in Western markets, heart failure represents a major burden for healthcare systems but is a highly attractive development market for pharmaceutical and medical device companies.

Scope

183 physician interviews carried out across the seven major pharmaceutical markets, including cardiologists and primary care physicians

Key opinion leader interviews carried out with heart failure specialists

Estimated prevalence and incidence of heart failure by country for the seven major pharmaceutical markets

Detailed treatment trees to show chronic and acute heart failure patient flows at country levels

Report Highlights
The diagnosis and treatment of chronic heart failure is sub-optimal with physicians failing to follow established guidelines. This suggests the need for continued physician education and a greater communication between the various physician types who manage heart failure patients.

Prevention along with improved treatment may be needed to stem the growth of heart failure and limit the societal burden of the disease.

Datamonitor's primary research reveals that acute heart failure patients experience a high rate of re-hospitalization, suggesting that there is a strong unmet need for more effective treatment in acute heart failure in order to improve outcomes. New therapeutic options may provide a solution to this issue.

Reasons to Purchase

Identify the future direction of therapy, the remaining unmet needs, and the opportunities for both pharmaceutical and medical device companies

Determine when and how therapies are prescribed, which compounds within each class lead prescriptions, and understand physician prescribing practices

Examine best patient treatment protocols and improvements that need to be made to produce better patient outcomes

ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Cardiovascular pharmaceutical analysis team - page 2
CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the heart failure market - page 5
  - The diagnosis and treatment of chronic heart failure is sub-optimal with physicians failing to follow established guidelines. This suggests the need for continued physician education and a greater communication between the various physician types who manage heart failure patients. - page 5
  - Prevention along with improved treatment may be needed to stem the growth of heart failure and limit the societal burden of the disease. - page 7
  - Primary research revealed that acute heart failure patients experience a high rate of re-hospitalization suggesting that there is a strong unmet need for more effective treatment in acute heart failure to improve outcomes. New therapeutic options may provide a solution to this issue. - page 8
  - Datamonitor recommendations - page 9
CHAPTER 2 INTRODUCTION AND SCOPE - page 17
- 2.1 Coverage of the Stakeholder Insight Survey - page 17
  - Section 1 - Epidemiology - page 17
  - Section 2 - Treatment patterns - page 17
  - Section 3 - Treatment outcomes - page 17
  - 2.1.1 Country level 'treatment trees' - page 19
  - 2.1.2 Supporting data sets - page 19
CHAPTER 3 COUNTRY TREATMENT TREES - page 20
CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION - page 66
- 4.1 Disease definition and classification - page 66
- 4.2 Epidemiology of heart failure - page 66
  - Prevalence of chronic heart failure - page 66
    - Methodology - page 67
  - Incidence of acute heart failure - page 68
    - Methodology - page 69
- 4.3 Key patient segmentations - page 72
  - Disease severity - page 72
  - Patient age - page 73
  - Ischemic versus non-ischemic heart disease - page 74
  - Systolic versus diastolic heart failure - page 75
- 4.4 Comorbidities, complications and risk factors - page 76
  - Left ventricular dysfunction - page 77
  - Hypertension - page 77
  - Other comorbidities - page 79
CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS FOR CHRONIC HEART FAILURE - page 80
- 5.1 Presentation and diagnosis - page 80
  - Diagnosis - page 80
- 5.2 Treatment guidelines - page 85
- 5.3 Drug classes prescribed - page 88
- 5.4 Combination therapy - page 107
- 5.5 Patient management - page 115
- 5.6 Follow-up - page 115
CHAPTER 6 DIAGNOSIS AND TREATMENT OPTIONS FOR ACUTE HEART FAILURE - page 118
- 6.1 Presentation and diagnosis - page 118
  - Diagnosis - page 118
- 6.2 Treatment guidelines - page 122
  - Drug therapy - page 122
- 6.3 Drug classes prescribed - page 126
- 6.4 Procedures prescribed - page 130
  - Surgical interventions - page 135
  - Mechanical assist devices - page 136
- 6.5 Patient management - page 137
CHAPTER 7 TREATMENT OUTCOMES - page 139
- 7.1 Hospitalizations for heart failure - page 139
  - Re-hospitalizations - page 140
    - Causes of re-hospitalizations - page 142
- 7.2 Heart failure progression and regression - page 143
- 7.3 Survival rates in heart failure - page 145
  - In-hospital mortality for acute heart failure - page 145
  - One- and five-year survival rates - page 146
    - Chronic heart failure - page 148
    - Acute heart failure - page 149
APPENDIX A - page 150
- Bibliography - page 150
  - Epidemiology sources - page 150
  - Clinical trial data - page 150
APPENDIX B - page 157
- Physician research methodology - page 157
  - Physician sample breakdown - page 157
  - US - page 157
  - Japan - page 158
  - France - page 158
  - Germany - page 159
  - Italy - page 159
  - Spain - page 160
  - UK - page 160
APPENDIX C - page 161
- The survey questionnaire - page 161
- 1. Diagnosis - page 161
- 2. Chronic Heart Failure - page 165
- Treatment - page 165
- 3. Acute Heart failure (patients treated in hospital) - page 173
- Treatment - page 175
- 4. Follow up - page 177
- 5. Patient outcomes - page 178
  - Disclaimer - page 181

List of Tables
Table 1: Current and future estimated prevalence of chronic heart failure in the seven major markets, 2005-15 - page 66
Table 2: Current and future estimated incidence of acute heart failure in the seven major markets, 2005-15 - page 69
Table 3: Segmentation of diagnosed chronic heart failure patients by disease severity, 2004 - page 73
Table 4: Prevalence of chronic heart failure by age groups (000s), 2005 - page 73
Table 5: Causes of heart failure in the seven major markets, 2004 - page 75
Table 6: Breakdown of heart failure patients according to whether failure is systolic, diastolic or both systolic and diastolic in the seven major markets, 2004 - page 76
Table 7: Estimated proportion of chronic heart failure patients with comorbid conditions and risk factors in the seven major markets, 2004 - page 76
Table 8: Concomitant cardiovascular and non-cardiovascular problems in the population enrolled in the EuroHeart Failure Survey Programme, 2003 - page 78
Table 9: Proportion of patients diagnosed with chronic heart failure by first consulting physician or referred for diagnosis, 2004 - page 81
Table 10: Symptoms used in the diagnosis of chronic heart failure in the seven major markets, 2004 - page 81
Table 11: Symptoms observed in chronic heart failure patients in the seven major markets, 2004 - page 82
Table 12: Tests used in the diagnosis of chronic heart failure in the seven major markets, 2004 - page 83
Table 13: Proportion of patients with chronic heart failure receiving each diagnostic test, 2004 - page 84
Table 14: Breakdown of chronic heart failure population by treatment strategy, 2004 - page 88
Table 15: Breakdown in the pharmacotherapy prescribed to chronic heart failure patients in the seven major markets, 2004 - page 90
Table 16: Proportion of chronic heart failure patients prescribed ACE inhibitors and ARBs in the seven major markets, 2004 - page 91
Table 17: Proportion of chronic heart failure patients prescribed diuretics in the seven major markets, 2004 - page 94
Table 18: Proportion of chronic heart failure patients prescribed beta blockers in the seven major markets, 2004 - page 95
Table 19: Proportion of chronic heart failure patients prescribed digoxin in the seven major markets, 2004 - page 97
Table 20: Proportion of chronic heart failure patients prescribed calcium channel blockers in the seven major markets, 2004 - page 98
Table 21: Proportion of chronic heart failure patients prescribed statins in the seven major markets, 2004 - page 98
Table 22: Proportion of chronic heart failure patients prescribed antiplatelet agents and oral anticoagulants in the seven major markets, 2004 - page 100
Table 23: Proportion of chronic heart failure patients prescribed aldosterone antagonists, 2004 - page 102
Table 24: Breakdown of aldosterone antagonist prescribing, 2004 - page 105
Table 25: Use of combination therapy for the treatment of chronic heart failure, 2004 - page 109
Table 26: Breakdown in the prescription of monotherapy for chronic heart failure by drug class, 2004 - page 110
Table 27: Breakdown in the prescription of two-drug combination therapy for chronic heart failure by drug class, 2004 - page 111
Table 28: Breakdown in the prescription of three-drug combination therapy for chronic heart failure by drug class, 2004 - page 112
Table 29: Breakdown in the prescription of four-drug combination therapy for chronic heart failure by drug class, 2004 - page 113
Table 30: Breakdown in the physician management of chronic heart failure patients in the seven major markets, 2004 - page 115
Table 31: Average number of times chronic heart failure patients have their therapy changed in a year in the seven major markets, 2004 - page 116
Table 32: Breakdown of the types of changes in chronic heart failure therapy in a given year, 2004 - page 116
Table 33: Proportion of respondents using each symptom for diagnosis in acute heart failure patients, 2004 - page 118
Table 34: Proportion of acute heart failure patients presenting with each symptom, 2004 - page 119
Table 35: Proportion of respondents using each test for diagnosis in acute heart failure patients, 2004 - page 120
Table 36: Proportion of acute heart failure patients receiving each test for diagnosis, 2004 - page 121
Table 37: Breakdown in the pharmacotherapy prescribed to acute heart failure patients in the seven major markets, 2004 - page 126
Table 38: Breakdown of procedures prescribed to acute heart failure patients, 2004 - page 131
Table 39: Mechanical assist devices recommended by the ESC in acute heart failure patients - page 137
Table 40: Breakdown in the physicians primarily responsible for the management of patients hospitalized with acute heart failure, 2004 - page 138
Table 41: Breakdown in heart failure hospitalizations by new vs. recurrent cases in the seven major markets, 2004 - page 139
Table 42: Precipitating events of newly hospitalized acute heart failure, 2004 - page 140
Table 43: Readmission data from the EuroHeart Failure Survey Program - page 141
Table 44: Proportion of acute heart failure patients who are re-hospitalized within a year, 2004 - page 141
Table 45: Primary causes of re-hospitalized acute heart failure, 2004 - page 142
Table 46: Reasons for unplanned hospital admissions - page 143
Table 47: Proportion of total heart failure patients progressing by one NYHA classification over the course of one year in the seven major markets, 2004 - page 144
Table 48: Proportion of heart failure patients regressing by one NHYA classification over the course of one year in the seven major markets, 2004 - page 145
Table 49: In-hospital mortality rate for acute heart failure patients in the seven major markets, 2004 - page 145
Table 50: Deaths on index admission and in total in the EuroHeart Failure Survey Programme - page 146
Table 51: One- and five-year survival rates for heart failure patients, according to disease severity, in the seven major markets, 2005 - page 148
Table 52: One- and five-year survival rates for acute heart failure patients, 2005 - page 149
Table 53: US physician sample breakdown, 2004 - page 157
Table 54: Japan physician sample breakdown, 2004 - page 158
Table 55: France physician sample breakdown, 2004 - page 158
Table 56: Germany physician sample breakdown, 2004 - page 159
Table 57: Italy physician sample breakdown, 2004 - page 159
Table 58: Spain physician sample breakdown, 2004 - page 160
Table 59: UK physician sample breakdown, 2004 - page 160

List of Figures
Figure 1: Diagrammatic overview of the coverage of the Stakeholder Insight: Heart Failure, 2005 - page 18
Figure 2: Breakdown of the chronic heart failure population in the US - page 22
Figure 3: Breakdown of diagnosis of chronic heart failure in the US - page 23
Figure 4: Breakdown of the treatment of chronic heart failure in the US - page 24
Figure 5: Breakdown of chronic heart failure treatment in the US - page 25
Figure 6: Breakdown of hospitalization and diagnosis of acute heart failure patients in the US - page 26
Figure 7: Breakdown of treatment of acute heart failure patients in the US - page 27
Figure 8: Breakdown of the chronic heart failure population in Japan - page 28
Figure 9: Breakdown of diagnosis of chronic heart failure in Japan - page 29
Figure 10: Breakdown of the treatment of chronic heart failure in Japan - page 30
Figure 11: Breakdown of chronic heart failure treatment in Japan - page 31
Figure 12: Breakdown of hospitalization and diagnosis of acute heart failure patients in Japan - page 32
Figure 13: Breakdown of treatment of acute heart failure patients in Japan - page 33
Figure 14: Breakdown of the chronic heart failure population in France - page 34
Figure 15: Breakdown of diagnosis of chronic heart failure in France - page 35
Figure 16: Breakdown of the treatment of chronic heart failure in France - page 36
Figure 17: Breakdown of chronic heart failure treatment in France - page 37
Figure 18: Breakdown of hospitalization and diagnosis of acute heart failure patients in France - page 38
Figure 19: Breakdown of treatment of acute heart failure patients in France - page 39
Figure 20: Breakdown of the chronic heart failure population in Germany - page 40
Figure 21: Breakdown of diagnosis of chronic heart failure in Germany - page 41
Figure 22: Breakdown of the treatment of chronic heart failure in Germany - page 44
Figure 23: Breakdown of chronic heart failure treatment in Germany - page 45
Figure 24: Breakdown of hospitalization and diagnosis of acute heart failure patients in Germany - page 46
Figure 25: Breakdown of treatment of acute heart failure patients in Germany - page 47
Figure 26: Breakdown of the chronic heart failure population in Italy - page 48
Figure 27: Breakdown of diagnosis of chronic heart failure in Italy - page 49
Figure 28: Breakdown of the treatment of chronic heart failure in Italy - page 50
Figure 29: Breakdown of chronic heart failure treatment in Italy - page 51
Figure 30: Breakdown of hospitalization and diagnosis of acute heart failure patients in Italy - page 52
Figure 31: Breakdown of treatment of acute heart failure patients in Italy - page 53
Figure 32: Breakdown of the chronic heart failure population in Spain - page 54
Figure 33: Breakdown of diagnosis of chronic heart failure in Spain - page 55
Figure 34: Breakdown of the treatment of chronic heart failure in Spain - page 56
Figure 35: Breakdown of chronic heart failure treatment in Spain - page 57
Figure 36: Breakdown of hospitalization and diagnosis of acute heart failure patients in Spain - page 58
Figure 37: Breakdown of treatment of acute heart failure patients in Spain - page 59
Figure 38: Breakdown of the chronic heart failure population in the UK - page 60
Figure 39: Breakdown of diagnosis of chronic heart failure in the UK - page 61
Figure 40: Breakdown of the treatment of chronic heart failure in the UK - page 62
Figure 41: Breakdown of chronic heart failure treatment in the UK - page 63
Figure 42: Breakdown of hospitalization and diagnosis of acute heart failure patients in the UK - page 64
Figure 43: Breakdown of treatment of acute heart failure patients in the UK - page 65
Figure 44: Relationship between cardiac dysfunction, heart failure and heart failure rendered asymptomatic, as defined by the European Society of Cardiology - page 86
Figure 45: ACC/AHA Practice Guidelines for the Evaluation and Management of Chronic Heart Failure - page 87

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Stakeholder Insight: Heart Failure

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