New models of care and treatment strategies in HFpEF

Dr John O'Sullivan, University of Sydney

2020 Future Leader Fellowship

Years funded: 2021-2024

Heart failure with a stiff heart but relatively preserved contraction (Heart Failure with preserved Ejection Fraction or ‘HFpEF’) has become the commonest type of heart failure in the community and hospital environment. Like the readily-recognised heart failure with reduced contraction (HFrEF), it has a poor outlook- typically patients survive about 2 years from diagnosis during which time they are chronically ill, have poor quality of life, and frequent admissions to hospital. Despite many scientifically-proven treatments for HFrEF, there are none for HFpEF. There is a pressing need to improve understanding of HFpEF, develop novel treatments, and implement these into clinical practice. Although patients with HFpEF collectively have similar heart abnormalities, we believe that there are several sub-classes corresponding to the most prevalent underlying conditions (high blood pressure, diabetes, sleep apnoea).

Therefore, we propose to:

1. Understand the key mechanisms underlying contributors to this disease (e.g. high blood pressure, diabetes, low oxygen due to sleep apnoea).
2. Improve characterisation of HFpEF subtypes using specialised tests such as cardiac MRI and sleep studies.
3. Using these results, design tailored models-of-care for each subtype (precision medicine).
4. Implement the tailored models-of-care and determine if they improve outcome.
5. In parallel, test a new heart-specific drug we are developing using human heart cells and human HFpEF heart tissue.