Search

Background/aim: Effective management of heart failure involves evidence-based use of multiple medications and their combinations. Furthermore, dosage escalation of the recommended medications is advised. In cases of advanced heart failure, long-term mechanical assistance devices or heart transplantation surgery may be necessary. Socio-economic disparities create unequal opportunities for people to access these treatments. The study aimed to analyze and compare medical and advanced heart failure treatments recommended by guidelines across various regions in Türkiye. Materials and methods: About 85 million citizens medical treatment records were utilized between January 1, 2016, and December 31, 2022. Medical and heart replacement treatment opportunities for heart failure in Türkiye were evaluated in the general population and across different geographical regions. Results: According to this study, beta-blockers were the most commonly prescribed medication for heart failure in Türkiye. This was followed by angiotensin-converting enzyme inhibitors at 44% and mineralocorticoid receptor antagonists at 38.9%. However, only 0.6% of patients used angiotensin receptor blocker-neprilysin inhibitors. Despite the high incidence of diabetes mellitus among heart failure patients, only 11% used sodium-glucose cotransporter two inhibitors. The study also found that using an implantable cardioverter defibrillator (ICD) was 0.8%, and cardiac resynchronization therapy (CRT) was 0.3% among all intracardiac device treatments. Heart replacement therapies, cardiac transplantation surgery, and long-term left ventricle-assisted device (LVAD) surgery had very low rates. Conclusion: The use of guideline-directed medical therapy is not optimal in Türkiye and varies across different geographical regions. It is a fact that heart transplant or LVAD surgery, CRT, and ICD implantation rates in Türkiye are significantly lower than those in developed countries, regardless of geographical region. [ABSTRACT FROM AUTHOR]

Background/aim: Despite Türkiye's relatively young population, there is an emerging trend of earlier diagnoses of chronic diseases, including heart failure (HF). This study aims to shed light on survival rates, potential influences of guideline-directed therapies, and sex-based differences necessitating personalized management in HF. Materials and methods: We conducted a nationwide retrospective cohort analysis of 2,722,151 patients with HF using deidentified data from the Turkish Ministry of Health's national electronic database. That cohort included 2,701,099 adult patients with HF. Adult patients were divided into two groups based on their outcomes as those who were deceased and those who survived and were then compared. Multivariate regression analysis was conducted to identify variables predicting mortality. The patients' hospital admissions and length of hospital stay were analyzed based on survival status and age. Results: Out of 2,722,151 HF patients, the overall mortality rate was 33.7%, with a difference observed according to sex (32.5% in female patients, 35.0% in male patients). Survival rates at 1, 5, and 7 years after the HF diagnosis were detailed. Deceased HF patients had more comorbidities, higher natriuretic peptides, and lower glomerular filtration rates. Hospitalization patterns varied, with 41% experiencing no hospitalization. The average length of hospital stay in 2022 was 6 days, with sex- and age-specific disparities. Conclusion: The survival rate of HF in Türkiye is similar to world data. The survival of female patients is better than that of male patients. Increased survival rates can likely be attributed to the widespread use of guideline-directed therapies. Finally, high healthcare utilization is observed, especially in emergency situations. [ABSTRACT FROM AUTHOR]

Background/aim: The epidemiological data on heart failure (HF) vary between regions within the same country. We aimed to investigate the epidemiological data on HF in Türkiye across all age groups regarding seven geographical regions. Materials and methods: We included all patients from the Turkish population who received a first diagnosis of HF between January 1, 2016 and December 31, 2022, using ICD-10 codes from the National Electronic Healthcare Database. The data were categorized by seven geographical regions of Türkiye. Results: The median age of index diagnosis of HF was 70 (60--78) years in all age groups and 4 (1--12) years in pediatric population. The prevalence rate of HF was the highest in the Black Sea Region at 3.103%, while the Southeastern Anatolia Region exhibited the lowest at 1.436%. In all age groups, female patients with HF were older and had a higher prevalence rate across all geographical regions than male patients. From 2017 to 2021, incidence rates of HF declined to 3.0 per 1000 person years, with a consistent decrease for each geographical region. The highest incidence rates of HF were seen in the Black Sea Region, while the Southeastern Anatolia Region had the lowest. Evaluating pediatric population with HF, prevalence of HF was 0.81 per 1000 people (female children: 0.77 per 1000 people, male children: 0.84 per 1000 people). Female children with HF demonstrated the highest prevalence in the Central Anatolia Region with a rate of 1.04 per 1000 people, while male pediatric population with HF exhibited the greatest prevalence of HF in the Mediterranean Region, reaching 0.89 per 1000 people. The lowest prevalence of children with HF in both sexes was observed in the Eastern Anatolia Region (female children: 0.62 per 1000 people, male children: 0.48 per 1000 people). Conclusion: Despite regional variations, prevalence of HF in Türkiye's regions aligns with global trends. Sex-based differences in HF prevalence were evident across all age groups, including pediatric population. Incidence rates of HF in each region exhibited a substantial decline by 2021. [ABSTRACT FROM AUTHOR]

Background/aim: Final diagnosis of heart failure (HF) relies on a combination clinical findings, laboratory and imaging tests. The aim of this study was to review the diagnostic approach to HF in Türkiye. Materials and methods: This study is a subanalysis of the nationwide TRends-HF study, based on anonymized data from National Electronic Database between January 1, 2016, and December 31, 2022. Variables including date of birth, sex, socioeconomic development index, place of initial HF diagnosis, comorbidities, investigations, and diagnostic procedures were reported. Laboratory variables, including complete blood count, natriuretic peptides (NP), estimated glomerular filtration rate, uric acid, electrolytes, albumin, lipid profile, ferritin and hemoglobin A1c levels, and other imaging techniques (coronary angiogram [CAG], transthoracic echocardiography [TTE], chest X-ray [CXR], etc.) during the initial diagnosis and/or follow-up of HF patients, were obtained from the National Electronic Database. The diagnostic test usage rates were analyzed according to years, geographical regions, and socioeconomic regions of Türkiye. Results: The study population consisted of 2,722,151 HF patients (51.7% female, mean age 68.33 ± 14.01 years). All HF patients had at least one electrocardiogram and one TTE examination, and all underwent routine biochemical tests at least once during the followup period. CXR utilization rate was 93.7%, while CAG utilization rate was 17.9%. Coronary computed tomographic angiography and cardiac magnetic resonance imaging were performed in only 1.8% and 0.3% of patients, respectively. Among all Turkish HF patients, 16.3% had at least one NP measurement. The highest rate of NP use was observed in the Central Anatolia Region (21.0%), while the lowest rate was in the Aegean Region (11.7%). NP measurement during HF diagnosis revealed a rising trend over time (12.3% in 2016 vs. 26.3% in 2021). Conclusion: The widespread use of TTE at the beginning of the diagnosis and during follow-up is important for providing quality care to HF patients in Türkiye. However, detailed laboratory tests and advanced imaging methods are not utilized sufficiently, which could lead to issues in patient management. [ABSTRACT FROM AUTHOR]

Background/aim: Heart failure (HF) is associated with a wide range of comorbidities that negatively impact clinical outcomes and cause high economic burden. We aimed to evaluate the frequency and burden of comorbidities in HF patients in Türkiye and their relationships with patients' demographic characteristics. Materials and methods: Based on ICD-10 codes in the national electronic database of the Turkish Ministry of Health covering the entire population of Türkiye (n = 85,279,553) from 1 January 2016 to 31 December 2022, data on the prevalence of comorbidities in HF patients were obtained. The frequency and burden of comorbidities were analyzed separately by age groups, sex, and socioeconomic status (SES). Results: Between 2016 and 2022, there were 2,722,151 patients (51.7% female) of all ages who were diagnosed with HF. In Türkiye, the most common comorbidities of HF patients were hypertension (HT) (97.6%), atherosclerotic cardiovascular disease (ASCVD) (84.9%), dyslipidemia (59.5%), anxiety disorder (48.1%), diabetes mellitus (DM) (45.2%), chronic obstructive pulmonary disease (COPD) (43.6%), anemia (40.6%), and atrial fibrillation (AF) (37.1%). Female patients had higher rates of anemia, DM, HT, and anxiety disorders, while male patients had higher rates of ASCVD, COPD, and dyslipidemia. The most common comorbidity in patients under 20 years of age was congenital heart disease (52.3%). More than 90% of HF patients had ≥2 comorbidities. HF patients with ≥5 comorbidities increased from 18.1% in the group aged 20--49 years to 38.3% in the group aged 50--79 years. Comorbidities were similar across SES groups. Conclusion: The most common comorbidities in cases of HF in Türkiye are HT, ASCVD, dyslipidemia, DM, COPD, anemia, and AF, respectively, and more than 90% of patients have ≥2 comorbidities. While ASCVD and dyslipidemia were more common in male patients, anemia, DM, and anxiety disorders were more common in female patients. The number of comorbid conditions increased with advanced age. [ABSTRACT FROM AUTHOR]

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We sought to investigate the impact of heart failure on anti-spike antibody positivity following SARS-CoV-2 vaccination. Our study included 103 heart failure (HF) patients, including those with and without left ventricular assist devices (LVAD) selected from our institutional transplant waiting list as well as 104 non-heart failure (NHF) patients who underwent open heart surgery at our institution from 2021 to 2022. All the patients received either heterologous or homologous doses of BNT162b2 and CoronaVac. The median age of the HF group was 56.0 (interquartile range (IQR): 48.0–62.5) and the NHF group was 63.0 (IQR: 56.0–70.2) years, and the majority were males in both groups (n = 78; 75.7% and n = 80; 76.9%, respectively). The majority of the patients in both the HF and NHF groups received heterologous vaccinations (n = 43; 41.7% and n = 52; 50.3%, respectively; p = 0.002). There was no difference in the anti-spike antibody positivity between the patients with and without heart failure (p = 0.725). Vaccination with BNT162b2 led to significantly higher antibody levels compared to CoronaVac alone (OR: 11.0; 95% CI: 3.8–31.5). With each passing day after the last vaccine dose, there was a significant decrease in anti-spike antibody positivity, with an OR of 0.9 (95% CI: 0.9–0.9). Furthermore, hyperlipidemia was associated with increased antibody positivity (p = 0.004). [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension guidelines recommend invasive right heart catheterization for diagnosis and clinical follow-up. Our aim was to compare non-invasive impedance cardiography with invasive techniques for cardiac index measurements and mortality prediction in patients with pulmonary hypertension. Methods: Between 2008 and 2018, 284 right heart catheterizations were performed for the diagnosis of pulmonary hypertension in 215 patients with mean pulmonary artery pressure >25 mm Hg, and at least 2 methods used for cardiac output measurement were included in the study retrospectively. Patients were evaluated with Pearson’s correlation in 3 groups: estimated Fick (eFick) method and thermodilution (group 1), eFick method and impedance cardiography (group 2), and thermodilution and impedance cardiography (group 3). We also compared the predictive power of cardiac index measured by different methods for 1-year overall mortality and hospitalizations. Results: There were strong and moderate positive correlations in groups 1 and 3, respectively (r=0.634, P < .001, r=0.534, P=.001), and the weakest correlation was in group 2 (r=0.390, P=.001). The mean difference (bias) between eFick method versus impedance cardiography, impedance cardiography vs. thermodilution, and eFick method vs. thermodilution was 0.6 mL/min, 0.47 mL/min, and −0.2 mL/min respectively, but limits of agreement were wide. In both groups, cardiac index <2.5 L/min/m² as measured by thermodilution significantly predicted 1-year mortality. Also, impedance cardiography was better than eFick method in predicting mortality (P=.02). Conclusions: Our single-center real-life data showed that for cardiac output and cardiac index measurements, impedance cardiography provides a moderate correlation with thermodilution and is fair with eFick method methods. Moreover, thermodilution appeared superior to both eFick method and impedance cardiography, while impedance cardiography was even better than eFick method in predicting 1-year adverse events, including total mortality and hospitalization, in patients with pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Risk assessment is recommended for patients with congenital heart disease-associated pulmonary arterial hypertension. This study aims to compare an abbreviated version of the risk assessment strategy, noninvasive French model, and an abridged version of the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management 2.0 risk score calculator, Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2. Methods: We enrolled a mixed prevalent and incident cohort of patients with congenital heart disease-associated pulmonary arterial hypertension (n = 126). Noninvasive French model comprising World Health Organization functional class, 6-minute walk distance, and N-terminal pro-hormone of brain natriuretic peptide or brain natriuretic peptide was used. Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2 includes functional class, systolic blood pressure, heart rate, 6-minute walk distance, brain natriuretic peptide/N-terminal pro-hormone of brain natriuretic peptide, and estimated glomerular filtration rate. Results: The mean age was 32.17 ± 16.3 years. The mean follow-up was 99.41 ± 58.2 months. Thirty-two patients died during follow-up period. Most patients were Eisenmenger syndrome (31%) and simple defects (29.4%). Most patients received monotherapy (76.2%). Most patients were World Health Organization functional class I-II (66.6%). Both models effectively identified risk in our cohort (P = .0001). Patients achieving 2 or 3 noninvasive low-risk criteria or low-risk category by Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2 at follow-up had a significantly reduced risk of death. Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2 approximates noninvasive French model at discriminating among patients based on c-index. Age, high risk by Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2, and the presence of 2 or 3 low-risk criteria by noninvasive French model emerged as an independent predictors of mortality (multivariate hazard ratio: 1.031, 95% CI: 1.005-1.058, P = .02; hazard ratio: 4.258, CI: 1.143-15.860, P = .031; hazard ratio: 0.095, CI: 0.013-0.672, P = .018, respectively). Conclusions: Both abbreviated risk assessment tools may provide a simplified and robust method of risk assessment for congenital heart disease-associated pulmonary arterial hypertension. Patients not achieving low risk at follow-up may benefit from aggressive use of available therapies. [ABSTRACT FROM AUTHOR]

Natriuretic peptides are widely used in all types of heart failure. Previously, we defined heart failure with non-reduced ejection fraction as patients with heart failure symptoms and/or signs and who have left ventricular ejection fraction > 40%.1 For the diagnosis of heart failure with preserved ejection fraction, the presence of raised natriuretic peptides is one of the major components of the diagnosis, and raised natriuretic peptides make the diagnosis more likely in patients with heart failure with mildly reduced ejection fraction.2 The majority of the existing studies have described the utility of natriuretic peptides in patients with heart failure with reduced ejection fraction, but there is not enough data on natriuretic peptides in heart failure patients with heart failure with non-reduced ejection fraction. Despite the insufficient information regarding the usage of natriuretic peptides in heart failure with non-reduced ejection fraction, it is obvious that there is an unmet need to guide how to use natriuretic peptides in these patients. The main goal of this article is to discuss the role of natriuretic peptides in diagnosis, prognosis, and guidance of heart failure treatment in patients with heart failure with non-reduced ejection fraction. The present review discusses the role of natriuretic peptides in heart failure with non-reduced ejection fraction focusing on: the characteristics of natriuretic peptides, primary prevention of heart failure, diagnosis of heart failure with non-reduced ejection fraction in different patient characteristics and co-morbidities, prognosis of heart failure, monitoring of heart failure treatment and, how to use in worsening heart failure. [ABSTRACT FROM AUTHOR]

This clinical consensus statement reviews the use of inotropic support in patients with advanced heart failure. The current guidelines only support use of inotropes in the setting of acute decompensated heart failure with evidence of organ malperfusion or shock. However, inotropic support may be reasonable in other patients with advanced heart failure without acute severe decompensation. The clinical evidence supporting use of inotropes in these situations is reviewed. Particularly, patients with persistent congestion, systemic hypoperfusion, or advanced heart failure with need for palliation, and specific situations relevant to implantation of left ventricular assist devices or heart transplantation are discussed. Traditional and novel drugs with inotropic effects are discussed and use of guideline‐directed therapy during inotropic support is reviewed. Finally, home inotropic therapy is described, and palliative care and end‐of‐life aspects are reviewed in relation to management of ongoing inotropic support (including guidance for maintenance and weaning of chronic inotropic therapy support). [ABSTRACT FROM AUTHOR]

Background/aim: Pulmonary arterial hypertension (PAH) is characterized by maladaptation of pulmonary vasculature which is leading to right ventricular hypertrophy and heart failure. miRNAs play a crucial role in the regulation of many diseases such as viral infection, cancer, cardiovascular diseases, and pulmonary hypertension (PH). In this study, we aimed to investigate the expression pattern of eight human plasma miRNAs (hsa-miR-21-3p, hsa-miR-143- 3p, hsa-miR-138-5p, hsa-miR-145-3p, hsa-miR-190a, hsa-miR-204-3p, hsamiR-206, hsa-miR-210-3p) in mild-to-severe PH patients and healthy controls. Materials and methods: miRNAs were extracted from the peripheral plasma of the PH patients (n: 44) and healthy individuals (n: 30) by using the miRNA Isolation Kit. cDNA was synthesized using All in-One First strand cDNA Synthesis Kit. Expression of the human plasma hsa-miR- 21-3p, hsa-miR-143-3p, hsa-miR-138-5p, hsa-miR-145-3p, hsa-miR-190a, hsa-miR-204- 3p, hsa-miR-206, hsa-miR210-3p, and miRNAs were analyzed by qRT-PCR. Results: According to our results, in PH patients hsa-miR-21-3p and hsa-miR-143-3p expression levels were decreased by 4.7 and 2.3 times, respectively. No significant changes were detected in hsa-miR-138-5p, hsa-miR-145-3p, hsa-miR-190a, hsa-miR-204-3p, hsamiR-206, and hsa-miR-210-3p expression levels between PH and control groups. In addition, considering the severity of the disease, it was observed that the decrease in miR-138, miR-143, miR-145, miR-190, mir-204, mir-206 and miR-208 expressions was significant in patients with severe PH. Conclusion: In the early diagnosis of PAH, hsa-miR-21-3p and especially hsa-miR-143-3p in peripheral plasma can be considered as potential biomarkers. [ABSTRACT FROM AUTHOR]

Aims: Left ventricular non‐compaction cardiomyopathy (LVNC) is a poorly understood entity resulting in heart failure. Whether it is a distinct form of cardiomyopathy or an anatomical phenotype is a subject of discussion. The current diagnosis is based on morphologic findings by comparing the compacted to non‐compacted myocardium. The study aimed to compare demographic and prognostic variables of patients with dilated cardiomyopathy (DCM) and LVNC. Emphasis was given to cardiac magnetic resonance (CMR) imaging analysis. Data on survival were also assessed. Methods and results: We retrospectively evaluated the characteristics and outcomes of 262 non‐ischaemic cardiomyopathy patients with LVNC and DCM phenotypes. Petersen's CMR criteria of non‐compacted to the compacted myocardial ratio 2.3 were used to diagnose LVNC. The primary endpoint was a composite endpoint of major adverse cardiovascular events comprising cardiovascular‐related death, left ventricular assisted device implantation, or heart transplantation. A total of 262 patients with CMR data were included in the study. One hundred fifty‐five patients who fulfilled CMR criteria were diagnosed as LVNC. CMR findings revealed that LVNC patients had higher left ventricular end‐diastolic (137.2 ± 51.6, 116.8 ± 44.6, P = 0.002) and systolic volume index (98.4 ± 49.5, 85.9 ± 42.7, P = 0.049). Cardiac haemodynamics, cardiac output (5.61 ± 2.03, 4.96 ± 1.83; P = 0.010), stroke volume (73.9 ± 28.8, 65.1 ± 25.1; P = 0.013), and cardiac index (2.85 ± 1.0, 2.37 ± 0.72; P < 0.0001), were higher in LVNC patients. Of all the 249 patients, 102 (40.9%) patients demonstrated late gadolinium enhancement (LGE). According to Petersen's criteria, the Kaplan–Meier survival outcome did not reveal significant differences (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: [0.89–2.63], P = 0.11). The presence or pattern of LGE did not show significant importance for endpoint‐free survival. Most of the sub‐epicardial LGE pattern was found in LVNC patients (94.4%). When receiver operator characteristics analysis was applied to NC/C ratio to discriminate the primary endpoint, a higher NC/C ratio of 2.57 was associated with adverse events (HR: 1.90, 95% CI: [1.12–3.24], P = 0.016). Conclusions: Our study questions the criteria being used for the diagnosis of LVNC. Further evaluation of CMR variables and association of these findings with demographic variables and survival is mandatory. [ABSTRACT FROM AUTHOR]

Objective: Peripartum cardiomyopathy (PPCM) diagnosis made by excluding identifiable causes of heart failure (HF) and occurs end of the pregnancy or during the postpartum period of five months. It presents a clinical HF spectrum with left ventricular systolic dysfunction. Background: The purpose of this study is to retrospectively evaluate the clinical characteristics, cardiac magnetic resonance (CMR) imaging features, and end‐points consisting of left ventricle recovery, left ventricular assist device implantation, heart transplantation, and all‐cause mortality. Method: Outpatient HF records between 2008 to 2021 were screened. Thirty‐seven patients were defined as PPCM. Twenty‐five patients had CMR evaluation at the time of diagnosis, and six patients were re‐evaluated with CMR. Results: The mean age was 30.5 ± 5.6 years, and the mean LVEF was 28.2% ± 6.7%. In 13(35.7%) patients, LVEF recovered during the follow‐up course. The median recovery time was 281(IQR [78–358]) days. LVEF on CMR was 35.3 ± 10.5, and three patients exhibited late gadolinium enhancement(LGE) patterns. Sub‐endocardial and mid‐wall uptake pattern types were detected. 18(75%) patients met the Petersen left ventricle non‐compaction cardiomyopathy(LVNC) criteria. Patients with NC/C ratio lower than 2.3 had lower LVEDVi and LVESVi (124.9 ± 35.4, 86.4 ± 7.5, p =.003; 86.8 ± 34.6, 52.6 ± 7.6, p =.006), respectively. The median follow‐up time was 2129 (IQR [911–2634]) days. The primary endpoint‐free 1‐year survival was 88.9% (event rate 11.1%), and 5‐year survival was 75.7% (event rate 24.3%). Conclusion: In a retrospective cohort of PPCM patients, 35.7% of patients' LVEF recovered, and the primary end‐point of free‐5‐year survival was 75%. Twenty‐five patients were assessed with CMR; three of four met the Petersen CMR‐derived LVNC at initial evaluation. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population Aims: To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective. Study Design: Cross-sectional cost of disease study. Methods: In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and nonpharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism. Results: 51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage. Conclusion: Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients. [ABSTRACT FROM AUTHOR]