Heart Failure Management and Coronary Artery Disease
Summary
Heart failure and coronary artery disease (CAD) represent interlinked global health challenges. Heart failure arises when the heart cannot maintain adequate blood flow, often classified by left ventricular ejection fraction (LVEF) into reduced (HFrEF) and preserved (HFpEF) phenotypes. Worldwide, CAD is the predominant cause of HFrEF, while HFpEF is increasingly associated with comorbidities such as hypertension, obesity and diabetes. Management of heart failure rests on a combination of lifestyle modification, pharmacotherapy, device implantation and revascularisation. First-line drugs include inhibitors of the renin–angiotensin–aldosterone system, beta-blockers and mineralocorticoid receptor antagonists; more recently, sodium-glucose cotransporter 2 inhibitors have demonstrated mortality and morbidity benefits across LVEF spectra. In patients with significant CAD, timely percutaneous coronary intervention or coronary artery bypass grafting can improve symptoms and long-term outcomes. Device therapies, such as implantable defibrillators and cardiac resynchronisation, further reduce sudden death and hospitalisations in selected HFrEF cohorts. Despite advances, HFpEF remains without uniformly effective therapies, and CAD-related heart failure continues to confer high risks of arrhythmia, ischaemic events and rehospitalisation. Integrated care pathways that combine multidisciplinary heart failure clinics with structured secondary prevention of CAD are emerging as models to improve quality of life and reduce health-care utilisation on a global scale.
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Heart Failure Management and Coronary Artery Disease publication trend
The graph below shows the total number of articles in heart failure management and coronary artery disease across all publications each year (not limited to Nature Index journals).
Technical terms
Left ventricular ejection fraction (LVEF): proportion of blood ejected from the left ventricle with each heartbeat, used to classify heart failure subtypes.
Heart failure with preserved ejection fraction (HFpEF): disorder in which normal LVEF coexists with impaired diastolic filling and elevated intracardiac pressures.
Epicardial adipose tissue (EAT): fat depot adjacent to the myocardium that releases bioactive mediators influencing inflammation and fibrosis.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors: medications that reduce renal glucose reabsorption and confer cardiovascular protection in heart failure.
Coronary artery disease (CAD): atherosclerotic narrowing of coronary vessels leading to myocardial ischaemia and a principal contributor to heart failure.
References
- Epicardial Fat Expansion in Diabetic and Obese Patients With Heart Failure and Preserved Ejection Fraction—A Specific HFpEF Phenotype. Frontiers in Cardiovascular Medicine (2021).
- Pharmacotherapies in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus (2021).
- Cardiovascular outcomes among elderly patients with heart failure and coronary artery disease and without atrial fibrillation: a retrospective cohort study. BMC Cardiovascular Disorders (2019).
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