TOPLINE

Among patients with advanced heart failure and reduced ejection fraction (AdvHFrEF) in Sweden, 1-year all-cause mortality significantly declined between 2003 and 2022, largely driven by reductions in cardiovascular (CV) mortality; however, uptake of AdvHF therapies remained low, even among potentially eligible patients.

METHODOLOGY

• Using data from the Swedish Heart Failure Registry, researchers examined 20-year trends in mortality and the use of AdvHF therapies among patients with AdvHFrEF between 2003 and 2022.
• They included 5323 patients (median age, 76 years; 23% women) with AdvHF, defined as the presence of New York Heart Association class III-IV symptoms, EF below 30%, and at least one HF hospitalisation within the previous 6 months.
• A subgroup of 1520 patients was considered potentially eligible for AdvHF therapies on the basis of age 70 years or below, no dialysis within the preceding 5 years, and no active cancer within the preceding 3 years. The median age was 63 years, and 18% were women.
• The researchers assessed 1-year all-cause mortality, CV and non-CV mortality, left ventricular assist device (LVAD) implantation, and heart transplantation over time.

TAKEAWAY

• In the overall AdvHFrEF cohort, 1-year all-cause mortality fell from 46.1 per 100 person-years in 2003 to 32.9 per 100 person-years in 2022, corresponding to an estimated average annual reduction of 3.8%.
• One-year CV mortality dropped from 35.4 per 100 person-years in 2003 to 25.2 per 100 person-years in 2022, representing an estimated average annual decline of 4.3%, whereas 1-year non-CV mortality did not decline significantly.
• Among patients eligible for AdvHF therapies, all-cause mortality fell from 22.1 per 100 person-years in 2004 to 19.9 per 100 person-years in 2022, corresponding to an estimated average annual decline of 3.2%, and CV mortality dropped from 15.5 to 11.1 per 100 person-years, representing an estimated average annual reduction of 5.6%.
• LVAD use rose steadily in the overall cohort and among patients eligible for AdvHF therapies, whereas heart transplantation did not increase significantly. Notably, uptake of both advanced therapies remained low, even among potentially eligible patients.

IN PRACTICE

"[The study] findings suggest that a considerable proportion of patients who may benefit from advanced therapies are not selected for them. Further improvements in outcomes may be achieved through earlier identification and timely referral of AdvHF patients, broader access to AdvHF therapies and the development of novel therapeutic options for patients who are not eligible for currently available advanced interventions," the researchers of the study wrote.

SOURCE

The study was led by Federica Guidetti, Karolinska Institute, Stockholm, Sweden. It was published online on July 22, 2026, in the European Journal of Heart Failure.

LIMITATIONS

The findings may not have fully applied to healthcare systems outside Sweden. Participants enrolled in the registry were generally younger, less comorbid, and more intensively treated than the broader HF population, which may have underestimated the risk for mortality. Changes in registry enrolment over time may have influenced the observed trends.

DISCLOSURES

This study received support through a grant from the Swedish Heart Lung Foundation. Some authors disclosed receiving speaker fees, consulting fees, research grants, speaker honoraria, consulting honoraria, and personal fees from multiple companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.