Are mechanical circulatory supports the forgotten aspect in the implementation of therapies for heart failure?

Overview & Synopsis

Heart failure (HF) is a frequent and severe condition. It is estimated that one in four patients will die within a year following hospitalization for acute decompensation, with significant variations across age strata. A recent study reported that the 1-year mortality following hospitalization for HF was 9%, 14%, and 18% for patients under 55, between 55-64, and 65-74 years, respectively. 1 Higher values are found when older and unselected patients are included. 2 Another rather recent worrisome finding is the increase in the incidence of HF among younger individuals due to a rise in ischaemic heart disease, especially among men aged 36-50 years in Europe. 3 Although younger than 50 years, this population will experience a 25% readmission rate for HF, and 75% for all causes with a mortality exceeding 10% at 2 years. 3 Consistent data show an increasing incidence of cardiogenic shock following myocardial infarction among the young, along with an associated increase in mortality from ischaemic cardiogenic shock within this same demographic. 4 Moreover, epidemiological data confirm that mortality due to HF among young individuals is generally on the rise in North America, even as the availability of treatments and devices continues to increase. 5 This subgroup of young patients who develop acute coronary syndrome followed by severe cardiac dysfunction and HF is an obvious target for treatment with long-term mechanical circulatory support (MCS) and heart transplantation.The treatment for HF with reduced ejection fraction relies on four therapeutic classes including beta-blockers, renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 inhibitors (SGLT2i), each with a class I recommendation. 6 Meta-analyses of randomized clinical trials demonstrate that the implementation of these four classes could reduce all-cause mortality by 61%, with an estimated increase in survival of 5 years for a patient who would be 70 years old. 7 However, tolerance of HF treatments is poor, with