Call to fund much-needed heart failure treatments

Half of the patients diagnosed with heart failure will die within five years if proper medical therapy is not started.

That's the stark reality from Interventional Cardiologist Dr Sarah Fairley, who is also the Medical Director of Kia Manawanui Trust (now the Cardiac and Respiratory Foundation NZ).

In New Zealand, heart failure is one of the most common reasons people are admitted to hospital.

Nearly 25% of patients admitted for heart failure also face an unplanned re-admission within just 30 days.

Even more worrying is the high risk of death after a person's first hospitalisation.

“Current statistics show that half of the patients diagnosed with heart failure will be dead in five years, which is truly shocking, and we need to do something about that,” Dr Fairley says.

Heart disease is the leading cause of death in New Zealand. Every 90 minutes, someone dies from heart disease in New Zealand.

Heart disease affects about 2 to 3% of all adults and more than 10% of those over 70, with a growing disparity among Māori and Pacific populations.

Māori experience a roughly 2.3 times higher rate of heart failure compared to non-Māori.

Starting the best treatment for heart failure early, when someone is first diagnosed, can significantly boost their quality of life and extend their lifespan, Dr Fairley says.

However, currently, in New Zealand, the most effective treatment for heart failure isn’t funded for everyone.

Heart failure means the heart isn’t pumping as effectively as it should, making it harder for the body to receive the oxygen-rich blood it needs.

The most common type - heart failure with reduced ejection fraction (HFrEF) - involves a weak heart muscle that can’t pump effectively, causing fluid to build up in the lungs, legs, or abdomen.

In New Zealand, it's often caused by ischaemic heart disease damaging the heart muscle due to poor blood flow.

The other type - heart failure with preserved ejection fraction (HFpEF) - occurs when the main pumping chamber (the left ventricle) pumps blood properly but cannot relax properly, leading to breathlessness.

It’s more common in people with long-term uncontrolled high blood pressure or in older patients.

The two types of heart failure are managed similarly with Guideline-Directed Medical Therapy (GDMT), also known as the 'four pillars' of heart failure treatment.

The ‘four pillars’ are critical in managing symptoms and slowing the progression of the disease.

While most of the treatments are funded, there are some with restrictions – and that has cardiologists around the country advocating for full funding.

Dr Fairley says cardiologists know the ‘four pillars’ approach works.

“Life expectancy increases with the 'four pillars' of heart failure treatment.

“For example, in a 55-year old, using all 4 classes of medications provides 8.3 additional years free of cardiovascular death or first hospitalisation for heart failure."

Prevention is crucial, she says.

“The 'four pillars’ medications keep people out of hospital and improve quality of life. If we treat patients early, we can genuinely make a big difference.

“We need access to medications for both treatment and prevention to keep our communities healthier, to save lives, and to reduce hospitalisations.”

Currently, three of the four pillars of heart failure treatment are generally funded, while the other is only funded with special authority restrictions.

In Australia and the UK, the drug is available to patients regardless of their heart’s function.