Introduction

We are at a crucial point in time for those with cardiovascular diseases such as heart failure (HF).

An estimated 64.3 million people are living with HF worldwide.¹ In developed countries, the prevalence of diagnosed HF is estimated at 1–2% of the adult population,^{2, 3} and with factors such as our expanding ageing population, figures are set to double by 2040 (Figure 1).

Heart failure is a final common pathway for almost all cardiovascular diseases, but also a significant cause of mortality across the wider cardio-renal-metabolic spectrum. Over 90% of those who are diagnosed with HF are living with at least one other long-term condition⁴ such as diabetes, kidney disease, high blood pressure, chronic obstructive pulmonary disease and depression. From epidemiology to pathophysiology, there is a large multi-specialty and multi-disciplinary overlap.

Diagnosing HF, however, remains a challenge. Eighty per cent of patients receive their diagnosis during an emergency admission.⁵ This is even though up to 40% of these patients had symptoms many months prior to that admission which should have triggered an earlier assessment.⁵ Delayed diagnosis has a significant impact on mortality and spending. One in three of these patients do not survive up to 1 year and inpatient costs are a significant driver of expenditure for HF care, which itself accounts for almost 2% (€2.3 billion) of the entire National Health Service (NHS) budget.⁶

Many patients with HF remain undetected and undiagnosed. In the UK alone, it is estimated that around 400 000 people who have HF remain without a documented diagnosis. These patients are disproportionately at risk of socioeconomic deprivation and associated worse outcomes, including more frequent exacerbations, repeated hospital admissions and increased HF mortality.⁷ The undetected and undiagnosed are deprived of life-preserving HF treatments. The human and economic costs are huge. It is time for action.

中文翻译：

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25in25 计划：一个新颖的变革性项目，旨在在未来 25 年内将心力衰竭死亡率降低 25%

 介绍

对于患有心力衰竭 （HF） 等心血管疾病的人来说，我们正处于一个关键时刻。

据估计，全世界有 6430 万人患有 HF。¹ 在发达国家，诊断出的 HF 患病率估计占成年人口的 1-2%，^2,3 并且由于人口老龄化等因素，到 2040 年，这一数字将翻一番（图 1）。

心力衰竭是几乎所有心血管疾病的最终常见途径，也是更广泛的心肾代谢谱系中死亡的重要原因。超过 90% 的被诊断患有 HF 的人至少患有另一种长期疾病⁴，例如糖尿病、肾病、高血压、慢性阻塞性肺病和抑郁症。从流行病学到病理生理学，存在大量的多专业和多学科重叠。

然而，诊断 HF 仍然是一个挑战。80% 的患者在紧急入院期间得到诊断。⁵ 尽管这些患者中高达 40% 的患者在入院前数月就出现了症状，这应该触发早期评估。⁵ 延迟诊断对死亡率和支出有重大影响。其中三分之一的患者无法存活长达 1 年，住院费用是 HF 护理支出的重要驱动力，其本身就占整个国家医疗服务体系 （NHS） 预算的近 2%（23 亿欧元）。⁶

许多 HF 患者仍未被发现和诊断。仅在英国，估计就有大约 400 000 名 HF 患者仍然没有记录在案的诊断。这些患者不成比例地面临社会经济剥夺和相关更糟糕结果的风险，包括更频繁的恶化、反复住院和 HF 死亡率增加。⁷ 未被发现和未确诊的人被剥夺了挽救生命的 HF 治疗。人力和经济成本是巨大的。现在是采取行动的时候了。