For heart failure patients, improvement may not be enough to stop treatment – Kaiser Permanente Division of Research

Report on Cardiovascular Research and its Alignment with Sustainable Development Goal 3

Introduction: Addressing Non-Communicable Diseases for Global Health

In alignment with the United Nations Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages, new research provides critical insights into the management of non-communicable diseases (NCDs). A study led by Kaiser Permanente researchers investigates the long-term treatment protocols for heart failure, a leading global NCD. This report details the study’s findings and their direct contributions to achieving SDG 3, particularly Target 3.4, which focuses on reducing premature mortality from NCDs through effective treatment.

Key Research Findings and Methodological Overview

Study Scope and Population

The research, published in the Journal of the American College of Cardiology, represents the largest U.S. assessment of patients with heart failure with improved ejection fraction (HFimpEF), a condition where heart function improves following initial treatment.

• The study included 28,292 members of Kaiser Permanente Northern California (KPNC) newly diagnosed with heart failure with a reduced ejection fraction (HFrEF) between 2013 and 2022.
• Within this cohort, 8,656 patients (30.6%) successfully transitioned to HFimpEF within one year of starting treatment.

Primary Outcomes and Clinical Significance

The central finding underscores the necessity of continued medical therapy even after cardiac function shows improvement. This directly informs clinical practices aimed at sustainable, long-term patient health.

1. Reduced Risk with Improvement: Patients who achieved HFimpEF experienced a 40% reduction in the risk of worsening heart failure or death compared to those whose condition did not improve.
2. Mortality and Morbidity Rates:
   • HFimpEF Group: 17 cases of worsening heart failure and 6 deaths per 100 person-years.
   • Unimproved Group: 34 cases of worsening heart failure and 11 deaths per 100 person-years.
3. Risk of Discontinuation: The study observed that medication use decreased over time among patients with improved ejection fraction. Those who stopped their medication were significantly more likely to experience worsening heart failure, highlighting a critical gap in patient adherence and long-term management.

Implications for Sustainable Development Goal 3: Good Health and Well-being

Contribution to Target 3.4: Reducing Premature Mortality from NCDs

The study’s findings are a direct contribution to the global effort to reduce premature deaths from NCDs like heart failure. By establishing that continuous treatment is vital for the HFimpEF population, the research provides an evidence-based strategy to prevent relapse and mortality. This reinforces the “treatment” component of Target 3.4, promoting long-term management over short-term recovery metrics.

• The research validates the 2022 American College of Cardiology/American Heart Association guidelines recommending sustained medication.
• It quantifies the ongoing risk, noting that over 20% of HFimpEF patients still faced worsening heart failure or death within three years, emphasizing that the underlying condition remains.

Supporting Target 3.8: Access to Quality Health Care and Medicines

This research highlights the importance of integrated health systems that ensure continuous access to essential, evidence-based medications. The findings demonstrate that achieving positive health outcomes is dependent not only on initial diagnosis and treatment but also on sustained access to and adherence to life-saving therapies, a core principle of universal health coverage as outlined in Target 3.8.

Broader Impact on Global Goals

Fostering Innovation and Research (SDG 9)

This study exemplifies the role of scientific research and innovation (SDG 9, Target 9.5) in advancing healthcare. By defining and analyzing the HFimpEF patient category, the research refines clinical understanding and pushes for more nuanced treatment protocols, upgrading the technological and scientific capabilities of the health sector.

Conclusion and Future Directives for Sustainable Health

The Kaiser Permanente study provides conclusive evidence that patients with heart failure with an improved ejection fraction require sustained medical therapy to maintain their health gains and prevent adverse outcomes. This aligns directly with the objectives of SDG 3 by offering a clear, actionable strategy for the long-term management of a major NCD.

Key Takeaways for Global Health Policy:

• Improving a patient’s ejection fraction does not signify a cure for heart failure; the heart remains vulnerable.
• Continued adherence to medication is critical for reducing mortality and morbidity, contributing directly to SDG Target 3.4.
• Patient education and robust healthcare systems that support long-term treatment are essential for sustainable health outcomes.
• Further research is needed to identify any low-risk subgroups that may eventually be able to de-escalate therapy, but current evidence strongly supports continued treatment for all.

Analysis of SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   • The article is entirely focused on health, specifically on the treatment and management of heart failure, which is a major non-communicable disease (NCD). It discusses medical research, patient outcomes, mortality rates, and treatment guidelines, all of which are central to ensuring healthy lives and promoting well-being.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   • The article directly addresses this target by examining the effectiveness of medications in treating heart failure, a critical NCD. The study’s findings show that continued treatment leads to a “40% reduction in the risk of worsening heart failure or death,” which is a direct contribution to reducing premature mortality from cardiovascular disease.

2. Target 3.b: Support the research and development of vaccines and medicines for the communicable and non-communicable diseases…

   • The article is a report on a “large new study” conducted by the Kaiser Permanente Division of Research. This research, published in the Journal of the American College of Cardiology, contributes to the global body of knowledge on treating NCDs. It supports the development of effective medicines and informs new “treatment guidelines,” which is the core of this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for Target 3.4 (Reducing mortality from NCDs)

   • Mortality Rate: The article provides specific data that can be used as an indicator. It states there were “6 deaths per 100 person years among the patients with an improved ejection fraction compared to … 11 deaths per 100 person years among the patients whose ejection fraction did not improve.”
   • Morbidity Rate: The article measures the incidence of “worsening heart failure,” a key morbidity indicator. It found “17 cases of worsening heart failure” in the improved group versus “34 cases” in the unimproved group per 100 person-years.
   • Clinical Outcome Measures: The “ejection fraction” itself is a key clinical indicator used to measure the effectiveness of treatment and the improvement of heart function.

2. Indicators for Target 3.b (Supporting R&D)

   • Research Output: The publication of the study in a major scientific journal (“Journal of the American College of Cardiology”) is a direct indicator of research and development activity.
   • Development of Guidelines: The article mentions that the research findings support the 2022 “treatment guidelines” from the American College of Cardiology and the American Heart Association, indicating that research is being translated into clinical practice.
   • Patient Cohort Size: The scale of the research (“28,292 members of Kaiser Permanente”) indicates a significant investment and capacity for conducting health services research.

4. Table of SDGs, Targets, and Indicators

Source: divisionofresearch.kaiserpermanente.org