UNMET NEED AHF/HF Disease Awareness

Morbidity and Mortality: Patients with heart failure are on a downward spiral, with frequent hospitalizations and high mortality rates With each acute event, myocardial injury may contribute to progressive left ventricular dysfunction Increasing frequency of acute events with disease progression leads to high rates of hospitalization and increased risk of mortality Cardiac function and quality of life Acute episodes Chronic decline Adapted from Gheorghiade et al. Am J Cardiol 2005;96:11–17; Gheorghiade and Pang. J Am Coll Cardiol 2009;53:557–73 Disease progression

HOSPITAL Resource and economic burden: Extensive resource utilization for heart failure Data from 1,892 European patients with acute heart failure in the European Society of Cardiology Heart Failure (ESC-HF) Pilot study; HF=heart failure; ICU=intensive care unit; 1. Korves et al. J Med Econ 2012;15:925–37; 2. Maggioni et al. Euro J Heart Fail 2010;12:1076–84 Median length of hospitalization is 8 days ‡2 48% of hospitalized patients will require admission to the ICU for a median period of 4 days ‡2 The GREATEST resource utilization occurs within 6 months of the initial hospitalization for HF 1 Treating patients with HF is RESOURCE INTENSIVE 1

Lack of awareness: The prevalence, symptoms and prognosis of heart failure is under-recognized by the public HF=heart failure Data from the Study on Heart failure Awareness and Perception in Europe (SHAPE), a survey of nearly 8,000 people from nine European countries (France, Germany, Italy, The Netherlands, Poland, Romania, Spain, Sweden, UK). People aged between 25–45 and 65–85 years old were randomly selected. An equal distribution of men and women, and people from urban and rural areas were chosen. Survey conducted in Remme et al. Eur Heart J 2005;26:2413–21 PEOPLE’S PERCEPTIONS OF HF 86 % have heard of HF… …but only 3 % can identify its signs and symptoms >70 % do not consider HF to be a serious condition 67 % wrongly believe that HF patients have a better prognosis than cancer patients

Unmet therapeutic need: There is a need for therapeutic advances in acute heart failure GroupMedication Class of recommendation Level of evidence † (A–C) DiureticsLoop diureticsIB VasodilatorsNitratesIIaB VasodilatorsSodium nitroprussideIIbB OpiatesMorphineIIaC InotropesDobutamineIIaC Limited evidence is available to guide treatment 1 †A=data derived from multiple randomized controlled trials (RCTs) or meta-analyses; B=data derived from a single RCT or large non-randomized studies; C=consensus of opinion of experts and/or data from small studies, retrospective studies, or registries 1. McMurray et al. Eur Heart J 2012;33:1787–1847 The evidence base for many commonly used acute HF treatments is limited with no long-term benefits proven 1

Growing burden on Healthcare Systems Item Code: Copyright © Novartis Pharma AG.