Experts establish key priorities to tackle the ‘forgotten heart failure disease’ in Lebanon

• Heart failure experts assess key unmet needs, barriers and opportunities for policy change to reduce heart failure morbidity rates in Lebanon at a meeting hosted by Novartis

Experts from across Lebanon came together today to establish a roadmap of priority actions for local care, intervention and policies specific to more than 72,000 heart failure patients living in the country.

Heart failure experts and policy makers from Lebanon attended the ‘Closing the Gaps in Heart Failure across MENA: special focus on Lebanon’ event to discuss findings from The MENA Heart Failure Roadmap Report - an in-depth study conducted by The Health Policy Partnership. The report assessed the unmet needs, barriers, and opportunities for policy change that may reduce the morbidity and mortality for MENA heart failure patients.

Today’s meeting follows the launch of the MENA Heart Failure Alliance in November, the region’s first dedicated group for heart failure management. The MENA Heart Failure Alliance is dedicated to combat heart failure, establish a clear roadmap of priority actions, and develop locally applicable interventions and policies following the key focus areas identified through the Roadmap Report findings.

The Heart Failure Roadmap report found that the MENA region has unique challenges in heart failure that require unique responses that will differ from one country to another. Studies suggest that re-hospitalisation rates are much higher in MENA than in other countries. These high re-admission rates are costly and often avoidable.

Hosted by the Lebanese Society of Cardiology in collaboration with global pharmaceutical company, Novartis, the regional event enabled the group to identify priority areas for heart failure management in Lebanon, which included; reviewing and changing policies to ensure timely diagnosis and optimal care pathways; continual care after discharge and the importance of advancing heart failure as a priority disease.

Speaking at the heart failure event, Dr Hadi Skouri, Cardiac Care Unit Director at the American University of Beirut Medical Center, said:

“Heart failure has been singled out as an emerging epidemic. The MENA region has one of the youngest populations of heart failure patients across the globe, with the MENA population developing heart failure 10 years younger than their western counterparts¹. Furthermore, despite striking improvement in the prognosis and survival in patients with coronary artery disease (CAD), hypertension, and congenital heart disease, the prevalence of heart failure continues to grow². Comprehensive studies estimating the prevalence of heart failure and its associated mortality are scarce in MENA; however, scattered data from individual studies are available³. Here in Lebanon, for example, we lack still a heart failure registry but considering the worldwide prevalence it is estimated that around 72,000 patients have heart failure.”⁴

Awareness of heart failure is low amongst the general public, healthcare professionals, and policymakers, which can affect all aspects of heart failure care. Moreover, heart failure-specific patient educational materials and multidisciplinary disease management programs that can lend appropriate support to patients and caregivers are often limited. This may result in late presentation, more frequent hospitalizations, inadequate self-care, and may limit the patients’ ability to make care or treatment decisions.

Heart failure often occurs when the heart muscle has suddenly become weak due to a heart attack or other illnesses affecting the heart, or by damage sustained more gradually due to diabetes, high blood pressure or coronary artery disease^6,7. Common risk factors of heart failure include high blood pressure, diabetes mellitus, hyperlipidaemia leading to CAD, cigarette smoking, khat chewing and obesity, many of which are associated with a more Western-type lifestyle and are presently highly prevalent in the Middle-East population.

Dr Antoine Sarkis, Cardiologist and President of Lebanese Society of Cardiology spoke at the meeting as well, saying:

“Today we have set a clear roadmap to tackle the burden of heart failure in banon. By bringing together a diverse group of specialized multidisciplinary healthcare professionals, we can increase awareness of the disease and ensure that patients and healthcare professionals can make informed decisions about disease management and treatment.”

“Accurate and comprehensive data collection on the burden of heart failure in Lebanon will be a top priority for us. Because of lack of data and proper tracking of the disease little attention is given to the diagnosis, management and prevention of heart failure."

In addition, Dr Sobhi Dada, Former President of Lebanese Society of Cardiology and Chairman of Cardiac Invasive & Noninvasive, Hammoud Hospital University Medical Center said:

“Heart failure is the number one reason for hospitalisation for people over 65 across the globe⁸, placing a huge social and economic burden on patients and their families. The pressures of heart failure are set to grow across MENA, driven by the high prevalence of risk factors for non-communicable diseases in the region, which are often left unchecked and unchallenged.”

“We need more frameworks and policies to support cardiovascular diseases and ensure heart failure is within those frameworks,” Dr Dada concluded.

Dr Tony Abdel Massih, Associate Professor in Cardiology at the University Saint-Joseph (USJ) in Beirut, said: “Understanding the sociocultural aspects affecting the disease will help develop locally applicable interventions and policies. Governments must urgently develop responses that are specific to the needs and circumstances of the region and each individual country.”.

Another key point of discussion was how to build continuous care pathways for heart failure patients in Lebanon. These include; recognising the importance of prevention; achieving timely and accurate diagnosis; ensuring patients receive best of care whilst in hospital, recognizing the importance of monitoring and maintenance of heart failure outside of hospital and; giving patients adequate tools and support for self-monitoring and self-management.

About Novartis

Novartis provides innovative healthcare solutions that address the evolving needs of patients and societies. Headquartered in Basel, Switzerland, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, cost-saving generic and biosimilar pharmaceuticals and eye care. Novartis has leading positions globally in each of these areas. In 2016, the Group achieved net sales of USD 48.5 billion, while R&D throughout the Group amounted to approximately USD 9.0 billion. Novartis Group companies employ approximately 118,000 full-time-equivalent associates. Novartis products are sold in approximately 155 countries around the world. For more information, please visit http://www.novartis.com.

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References

1. Hospitalized heart failure patients with preserved vs. reduced ejection fraction in Dubai, United Arab Emirates: a prospective study. European Journal of Heart Failure (2014) 16, 454–460.
2. Gulf Care: Heart failure in the Middle East, Glob Cardiol Sci Pract. 2015; 2015(3): 34. Published online 2015 Oct 2, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625206/ (last accessed 8.11.16).
3. Al-Shamiri, M. Q. (2013). Heart Failure in the Middle East. Current Cardiology Reviews, 9,174-178. doi:10.2174/1573403X11309020009.
4. Deek H, Noureddine S, Newton PJ, et al. A family-focused intervention for heart failure self-care: conceptual underpinnings of a culturally appropriate intervention. Journal of advanced nursing 2015.
5. TNS UK Limited, March 2014. Survey of 11,000 members of the public aged 50+ years old in Europe, funded by Novartis Pharmaceuticals.
6. Harrison’s ‘Principles of Internal Medicine’. Seventeenth Edition pages 1442 – 1455.
7. Mosterd A, Hoes, A. Clinical epidemiology of heart failure. Heart 2007; 93:1137-1146.
8. Zannad F. et al. Heart failure burden and therapy. Europace 2009, 11;v1-v9.