The 25in25 initiative: A novel transformative project to reduce mortality due to heart failure by 25% in the next 25 years

Introduction

We are at a crucial point in time for those with cardiovascular diseases such as heart failure (HF).

An estimated 64.3 million people are living with HF worldwide.¹ In developed countries, the prevalence of diagnosed HF is estimated at 1–2% of the adult population,^{2, 3} and with factors such as our expanding ageing population, figures are set to double by 2040 (Figure 1).

Figure 1

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Projected total number of diagnosed cases for the 10 conditions with the highest impact on healthcare use and mortality among those aged 30 years and older, including demographic changes, England, 2019 and projected for 2040. Attrib. Health Foundation REAL Centre.¹³ Analysis of linked healthcare records and mortality data conducted by the REAL Centre and the University of Liverpool. Red shaded bars represent uncertainty intervals. COPD, chronic obstructive pulmonary disease.

Heart failure is a final common pathway for almost all cardiovascular diseases, but also a significant cause of mortality across the wider cardio-renal-metabolic spectrum. Over 90% of those who are diagnosed with HF are living with at least one other long-term condition⁴ such as diabetes, kidney disease, high blood pressure, chronic obstructive pulmonary disease and depression. From epidemiology to pathophysiology, there is a large multi-specialty and multi-disciplinary overlap.

Diagnosing HF, however, remains a challenge. Eighty per cent of patients receive their diagnosis during an emergency admission.⁵ This is even though up to 40% of these patients had symptoms many months prior to that admission which should have triggered an earlier assessment.⁵ Delayed diagnosis has a significant impact on mortality and spending. One in three of these patients do not survive up to 1 year and inpatient costs are a significant driver of expenditure for HF care, which itself accounts for almost 2% (€2.3 billion) of the entire National Health Service (NHS) budget.⁶

Many patients with HF remain undetected and undiagnosed. In the UK alone, it is estimated that around 400 000 people who have HF remain without a documented diagnosis. These patients are disproportionately at risk of socioeconomic deprivation and associated worse outcomes, including more frequent exacerbations, repeated hospital admissions and increased HF mortality.⁷ The undetected and undiagnosed are deprived of life-preserving HF treatments. The human and economic costs are huge. It is time for action.