Heart failure is a major cause of morbidity and mortality. However, efforts to reduce cases have been hampered by its complex relationship with other medical conditions and risk factors. New research provides the first systematic review of opportunities to prevent heart failure.

The challenge

Dozens of risk factors have been identified for heart failure, including high blood pressure and diabetes. However, it is still not fully understood how important these risk factors are and the value of their use in preventing the condition, as they have not been systematically evaluated. This could limit the success of campaigns to reduce heart failure cases.

The complex interrelationship between the risk factors makes it difficult to study how they contribute individually. However, analysing large-scale data from health records presents an opportunity to understand the role of these factors.

The solution

Researchers, including some funded by HDR UK, studied electronic health records of 170,885 people with heart failure.

The team reviewed international guidelines and identified 92 risk factors for heart failure, which they searched for in the patient records. This allowed them to determine when the risk factors were diagnosed relative to the heart failure diagnosis, which were the most common and how often they appeared together.

The analysis, published in the European Journal of Heart Failure, is the first time that prevention opportunities across a wide range of risk factors for heart failure have been systematically reviewed.

Impact and outcomes

Of the risk factors studied, only 13 had previously been shown to prevent heart failure or cardiovascular disease, if treated. The study found that five out of six people with heart failure had at least one of these preventative risk factors. This suggests that clinicians could focus on identifying and managing these to help reduce cases of heart failure.

The remaining risk factors that are not preventative could be used as a prompt for clinicians to ask their patients about symptoms of heart failure or do scans. This could help to diagnose the condition at an earlier stage. In the five years before a diagnosis of heart failure, almost half of people had four or more risk factors.

The relationship between heart failure and risk factors could even be used the other way round. For example, when speaking with patients with established heart failure, clinicians could investigate signs of treatable risk factors, like diabetes or high blood pressure.

Lead author of the paper, Amitava Banerjee, professor of clinical data science and cardiologist at University College London, said:

“Being a clinician, I had seen in guidelines that there’s a big list of risk factors for heart failure, but nobody ever tried to study all of them together. That’s partly because it’s hard to do that at scale in a research cohort. But in routine health records, there’s an opportunity to look across a really wide range of risk factors.”

Impact committee

The impact committee noted that this paper demonstrated the need for clinical trials to understand the benefit of targeting risk factors. They also recognised that this approach, which involved a broad collaboration, could be used as a basis for analysing further areas of cardiovascular health and other conditions.

Read the full paper