Aim
The European Society of Cardiology (ESC) recently published a modified definition in their 2021 heart failure (HF) guidelines, providing a new diagnostic and therapeutic algorithm. The aim of this study was to describe the prevalence of HF in a contemporary, well-characterized, prospectively enrolled sample from the general population and to assess the impact of the new ESC HF guidelines.

Methods and Results 
This analysis was conducted among 7074 participants (aged 45-78 years, 51.5% women) from the population-based Hamburg City Health Study. Compared to the 2016 version, HF prevalence increased with the 2021 HF guidelines from 4.31% to 4.83% (12% increase). This increase was driven by a higher prevalence of HF with reduced/mildly-reduced ejection fraction (0.47% to 0.52%; 1.37% to 2.12%), while the prevalence of HF with preserved ejection fraction decreased (2.46% to 2.19%). Importantly, risk factor profiles of the phenotypes remained as expected. As suggested by the guidelines “tailored treatment” approach, all patients with HF with reduced ejection fraction were eligible for treatment with the four main HF treatments; and several adjunctive therapies were indicated in dedicated cases/scenarios (e.g. <1% eligibility for ivabradine/vericiguat/devices).

Conclusion
HF remains common in this contemporary, well-characterized, prospectively enrolled sample from the general population. The number of patients with HF will increase when the current diagnostic criteria are applied, especially leading to a higher prevalence of HF with reduced/mildly-reduced ejection fraction. This offers opportunities to improve guideline-recommended treatment, especially considering the newly proposed “tailored treatment” approach.