Putting hearts first when it comes to aging healthily – POLITICO

In 2021, approximately 20.5 million people died from a heart-related condition, far outnumbering the death toll from COVID-19 or any other disease.^1,2 With an aging population (the number of people aged 60-plus is expected to double by 2050 to 2.1 billion),³ health care systems are set to face an influx of age-related conditions such as type 2 diabetes and hypertension, putting people at higher risk of heart failure.

Collectively called cardiometabolic diseases, they are a huge threat to our collective health and the strength of our global health ecosystems. The economic burden of heart failure is estimated to cost €282 billion per year in Europe.⁴ In recognizing the scale of the problem, the U.N.’s Decade of Healthy Ageing (2021-2030) is a global collaboration aimed at ‘adding life to our years’ and aligns with the final 10 years of the Sustainable Development Goals, which include reducing premature mortality from noncommunicable diseases.

Keeping hearts healthy as people age

The signs and symptoms of heart failure are often non-specific, or do not present at all.⁵ This, coupled with people’s busy lives and low awareness of symptoms, can mean their heart health is not prioritized. There is a clear need to raise awareness of non-specific heart symptoms while supporting people in managing known risk factors, such as obesity and tobacco use.

“To ensure that heart health is maintained as people age, we need to increase people’s understanding and recognition of heart failure symptoms. We need to raise awareness, in collaboration with healthcare professionals, patient advocates and patient organizations, and encourage people to proactively get tested,” said Aistė Štaraitė, chair of the Global Heart Hub’s Heart Failure Patient Council.

Addressing this burden requires the implementation of national cardiometabolic disease strategy and action plans — such as Spain’s Cardiovascular Health (CVH) Strategy^6,7 — that include clear mandates to invest in prevention, early detection, diagnostics and management strategies across the care continuum. This includes a need for transformation in care pathways to integrated, multidisciplinary disease management program approaches that break down silos in care. A more integrated approach for co-morbid cardiometabolic patients could improve patient outcomes and provide health system and economic benefits. 

The value of diagnostics in heart health

Alongside education and integration of care, priority must be placed on making diagnostic testing accessible to support patients in taking control of their own health. Identifying those most at risk of developing heart failure before symptoms appear and early diagnosis contribute to putting them on track for the most effective and integrated treatment route.

A blood test can be used to detect the presence of natriuretic peptides (NP), a biomarker in the blood that indicates heart failure when levels are high.⁸ Despite the relative simplicity of this test and its inclusion in European guidelines for use in primary care as well as for use in people with diabetes when heart failure is suspected,^9,10 nearly 80 percent of heart failure cases are only diagnosed after being admitted to an emergency room.¹¹ By this point, irreversible damage may have already occurred. What’s more, a study in the United Kingdom, shows that in primary care, only 25 percent of patients diagnosed with heart failure had access to the test six months prior to the diagnosis.¹¹

Policymakers should focus on expanding access to heart failure diagnostic tests such as NP, including those with comorbidities like type 2 diabetes, through supporting initiatives like the ‘3 As’ strategy which aims to increase Awareness, Access and Adoption of NP testing in primary care. Another opportunity lies in investing in diagnostic capacity through boosting and diversifying the healthcare workforce, especially in primary care, to help to reduce the acute pressures on emergency care while supporting individuals with a greater understanding of their heart health.

Improving equitable access to diagnostics

The value of diagnostics in cardiometabolic disease is clear, bringing significant patient, societal and economic benefits, yet investment is required both in the development of novel diagnostics and, more pressingly, in overcoming the barriers to accessing existing diagnostics. In-vitro diagnostics, tests conducted on blood or tissue, support nearly 70 percent of health care decisions but account for just 2 percent of global health care funding.¹²

“There is growing inequality in access [to diagnostics] across our health systems, and also in our understanding of the value of diagnostic information,” said Hans Martens, president of the General Assembly, European Association of Value-Based Health.

This call for greater access now has international backing. At the 76th World Health Assembly, representatives from governments around the world adopted a resolution on strengthening diagnostics capacity. This promising step is incredibly important since less than 50 percent of the world’s population have little to no access to essential diagnostics, and this number is up to 81 percent in low-income countries.¹³ The resolution has the potential to be a crucial building block in expanding access to diagnostics and, by extension, achieving universal health coverage. It states the need to establish national strategies, develop relevant skills throughout the workforce, strengthen laboratory systems and infrastructure, and adopt regulatory frameworks that accelerate access.

A call to action for heart health

With an aging population and the 2030 Sustainable Development Goals deadline fast approaching, now is the time to take action for a healthier future for all. We must invest to increase access to diagnostic testing globally alongside increasing education and implementing cardiometabolic action plans and integrated care pathways that support the prevention, diagnosis, prognosis and monitoring of heart health to improve health outcomes and better manage our health resources as the population ages, helping people enjoy longer and healthier lives.

Hear more from experts about the value of diagnostics in maintaining heart health as people age.

References

1. World Heart Federation. Deaths from cardiovascular disease surged 60% globally over the last 30 years: report. Available at: https://world-heart-federation.org/news/deaths-from-cardiovascular-disease-surged-60-globally-over-the-last-30-years-report/. Accessed: August 2023.
2. Our World in Data. Causes of death. Available at: https://ourworldindata.org/causes-of-death#:~:text=Cardiovascular%20disease%20is%20the%20top,cardiovascular%20diseases%20across%20the%20world. Accessed: August 2023.
3. World Health Organization. Ageing and health. Available at: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health#:~:text=By%202050%2C%20the%20world’s%20population,2050%20to%20reach%20426%20million. Accessed: April 2023.
4. Luengo-Fernandez R, et al. Economic burden of cardiovascular diseases in the European Union: a population-based cost study, European Heart Journal, 2023;, ehad583, https://doi.org/10.1093/eurheartj/ehad583.
5. American Heart Association. Managing Heart Failure Symptoms. Available at:  https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure/managing-heart-failure-symptoms. Accessed: August 2023.
6. Cardiovascular Health Strategy, Spain’s National Health System Executive Summary. Available at: https://www.sanidad.gob.es/organizacion/sns/planCalidadSNS/pdf/ESCAV_Executive_Summary.pdf. Accessed: August 2023.
7. Cardiovascular Health Strategy, Spain’s National Health System. Available at: https://www.sanidad.gob.es/organizacion/sns/planCalidadSNS/pdf/ESCAV_Summary_Presentation.pdf. Accessed: August 2023.
8. Kimmoun A, et al. Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP and GDF-15, of Heart Failure therapies (STRONG-HF): rationale and design for a multicentre, randomized, parallel-group study. Eur J Heart Fail. 2019 Nov;21(11):1459-1467.
9. Bayes -Genis A, Rosano G. Unlocking the potential of natriuretic peptide testing in primary care: A roadmap for early heart failure diagnosis. European Journal of Heart Failure. 2023;25(8): 1181-1184.
10. Marx N, et al. ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Aug 25:ehad192. doi: 10.1093/eurheartj/ehad192. Epub ahead of print. PMID: 37622663.
11. British Heart Foundation. Rushed to hospital: when heart failure isn’t diagnosed early enough. Available at: https://www.bhf.org.uk/for-professionals/healthcare-professionals/blog/2019/rushed-to-hospital-when-heart-failure-isnt-diagnosed-early-enough. Accessed: August 2023.
12. Rohr UP, Binder C, Dieterle T, et al. The Value of In Vitro Diagnostic Testing in Medical Practice: A Status Report [published correction appears in PLoS One. 2016;11(4):e0154008]. PLoS One. 2016;11(3):e0149856. Published 2016 Mar 4. doi:10.1371/journal.pone.0149856
13. Fleming KA, et al. The Lancet Commission on diagnostics: transforming access to diagnostics. The Lancet. 2021;398: 1997-2050