Heart Failure patient journey: how patients arrive at diagnosis (46% at an acute admission, 34% through a specialist, 20% in primary care), then diagnosis, four foundational classes in line 1, an add-on line, device and advanced therapy, then progression or switch — with three roadblocks: one patient in five undiagnosed, 78% short of the full regimen, add-ons started after an event.

Heart Failure treatment algorithm in three lines: 900,000 treated patients in line 1 on up to four foundational classes, 22% on all four at target dose; 14% reach a line-2 add-on; 8% reach device and advanced therapy.

The seven marketed Heart Failure classes compared by line of therapy on generic status, efficacy, tolerability, annual net cost and share of treated patients.

Each dimension carries what the current standard of care delivers, what it leaves unresolved, and how large the residual gap is.

• EfficacyDelivered by the standard of careEvent rates fall substantially on four foundational classesResidual unmet needResidual risk of CV death and HF hospitalisation persists on optimised therapyHigh›
• Symptoms and quality of lifeDelivered by the standard of careSymptoms and functional capacity improve once therapy is titratedResidual unmet need34% of treated patients stay NYHA III, with breathlessness and fatigue on exertionHigh›
• Disease coverageDelivered by the standard of careEvery foundational class is indicated across HFrEFResidual unmet needHFpEF and advanced heart failure are reached by fewer classesHigh›
• DurabilityDelivered by the standard of careBenefit is maintained for as long as treatment continuesResidual unmet needNo option holds the benefit once treatment stopsMedium›
• Safety and tolerabilityDelivered by the standard of careManageable with monitoring and stepwise titrationResidual unmet needHyperkalaemia and hypotension cap titration to target doseMedium›
• Administration burdenDelivered by the standard of careOral, in ambulatory care, once or twice dailyResidual unmet needFour classes, titration visits and polypharmacyMedium›