Heart failure with reduced ejection fraction: clinical and economic burden and insights into current and emerging treatments.

Heart failure (HF) imposes a large and growing burden on the population, with a prevalence that is projected to increase to more than 8 million adults by 2030. The high risk of morbidity and mortality associated with HF is further exacerbated by the frequent presence of comorbidities. The coexistence of HF and comorbid conditions can result in emergency department visits and hospitalizations that not only affect patients and their families but also pose a growing economic burden on health care systems. The largest costs arise from hospitalization for HF, with outpatient care and associated medication costs comprising the second largest component. For patients with HF with reduced ejection fraction (HFrEF), defined as left ventricular ejection fraction of 40% or less, remarkable improvements in outcomes have been observed in recent decades due to the availability of disease-modifying therapies. However, the management of HFrEF remains suboptimal, with many patients either not receiving guideline-directed medical therapy (GDMT) or experiencing delays in receiving target doses. Since this can result in preventable hospitalizations and deaths, action is needed to ensure rapid initiation of GDMT. Optimal treatment can be hindered by such patient factors as the presence of comorbidities and socioeconomic barriers that include the cost of multiple treatments. Furthermore, poor treatment adherence is common among patients with HF. Measures aimed at tailoring therapies to individual patients and reducing medical costs are important to increase the uptake of and adherence to therapy and therefore improve clinical outcomes.