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Introduction: This consensus statement of Australian clinicians provides new recommendations for the pharmacological management of heart failure based on studies reported since the publication of the 2018 Australian heart failure guidelines.Main Recommendations: ▪Use of sodium-glucose cotransporter 2 (SGLT2) inhibitors to prevent hospitalisation for heart failure in type 2 diabetes mellitus can be extended to patients with multiple cardiovascular risk factors, albuminuric chronic kidney disease, or atherosclerotic cardiovascular disease. ▪New evidence supports the use of a mineralocorticoid receptor antagonist (finerenone) to prevent heart failure in type 2 diabetes mellitus associated with albuminuric chronic kidney disease. ▪In addition to renin angiotensin system inhibitors (angiotensin receptor neprilysin inhibitor preferred), beta blockers and mineralocorticoid receptor antagonists, an SGLT2 inhibitor (dapagliflozin or empagliflozin) is recommended in all patients with heart failure with reduced left ventricular ejection fraction (LVEF ≤ 40%) (HFrEF). Lower quality evidence supports these therapies in patients with heart failure with mildly reduced LVEF (41-49%) (HFmrEF). ▪A soluble guanylate cyclase stimulator (vericiguat), selective cardiac myosin activator (omecamtiv mecarbil) and, if iron deficient, intravenous iron (ferric carboxymaltose) provide additional benefits in persistent HFrEF. ▪An SGLT2 inhibitor (empagliflozin) should be considered in patients with heart failure with preserved LVEF (≥ 50%) (HFpEF). Key changes in management from this statement: This document broadens the scope of angiotensin receptor neprilysin inhibitor use in patients with HFrEF and HFmrEF. SGLT2 inhibitor use expands to become a cornerstone therapy in HFrEF, with increasing evidence to support its use in HFmrEF and HFpEF. [ABSTRACT FROM AUTHOR]

In this document, we propose a universal definition of heart failure (HF) as a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. We also propose revised stages of HF as: At risk for HF (Stage A), Pre-HF (Stage B), Symptomatic HF (Stage C) and Advanced HF (Stage D). Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). This includes HF with reduced ejection fraction (HFrEF): symptomatic HF with LVEF ≤40%; HF with mildly reduced ejection fraction (HFmrEF): symptomatic HF with LVEF 41-49%; HF with preserved ejection fraction (HFpEF): symptomatic HF with LVEF ≥50%; and HF with improved ejection fraction (HFimpEF): symptomatic HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF > 40%., (© 2021 European Society of Cardiology and Elsevier, Inc.)

Background: The epidemiology of heart failure is poorly understood. Australia has one of the highest rates of cardiovascular disease in the world with heart failure representing a large proportion of this group, yet there is minimal data on the incidence or prevalence., Aims: To determine the epidemiological impact of heart failure in Australia by assessing mortality and morbidity data., Methods: Data were obtained from National and State health organisations in terms of morbidity and mortality of heart failure. Data were obtained from several sources so as to provide a comprehensive picture of the available epidemiological data on heart failure., Results: The mortality rates associated with heart failure have been decreasing substantially over the last 20 years. However, there appears to be a stabilisation of heart failure presentations over the last decade, both nationally and in the state of New South Wales. Extrapolation of the data to assess prevalence of heart failure in the community was not possible., Conclusions: Currently, mortality rates for heart failure are decreasing in Australia, while there does not appear to be any real increase in the numbers of patients admitted to hospital with a subsequent diagnosis of heart failure over a 10 year period.

Objectives: To investigate the perceptions of Australian health and medical researchers 4 years after the Wills Report recommended and led to a substantial increase in health and medical research funding in Australia., Design, Setting and Participants: A telephone poll of 501 active health and medical researchers, conducted between 28 April and 5 May, 2003., Main Outcome Measures: Researchers' views on the adequacy of funding, infrastructure and support, salary, community recognition, the excitement of discovery and research outcomes such as publication and patenting in research., Results: Research funding was the most important concern: 91% of researchers (455/498) viewed funding as "very" or "extremely" important to their role, but only 10% (52/500) were "very" or "extremely" satisfied with the level of funding. Research infrastructure and support were seen as "very" or "extremely" important by 90% of researchers (449/501), while only 21% (104/501) were "very" or "extremely" satisfied. Researchers in medical research institutes were significantly more likely to be satisfied (27% [56/205] "very" or "extremely" satisfied) with the level of infrastructure and support than those working in universities (15% [41/268] "very" or "extremely" satisfied; P = 0.001). Among the factors that motivate researchers, the excitement of discovery stood out in terms of both high importance and satisfaction. Publications were viewed as more important research outcomes than patenting or commercial ventures., Conclusions: Funding and infrastructure support remain overwhelmingly researchers' greatest concerns. University-based researchers were less satisfied with infrastructure and support than those in independent medical research institutes.