Introduction

Heart failure presents a significant challenge as a noncommunicable disease, with its prevalence steadily rising globally, and projections indicate this trend will continue in the coming years. The complexity of heart failure arises from the diverse range of underlying causes, leading to varying responses to treatment. Numerous conditions contribute to the development of heart failure, including ischemic cardiomyopathy, valvular disease, hypertensive heart disease, atrial fibrillation, cardiac amyloidosis, myocarditis, and dilated cardiomyopathy. This diversity in etiology complicates clinical decision-making, as treatment effects differ greatly among individuals. There's an ongoing debate among researchers, including our own group, regarding the importance of early prediction of treatment efficacy in guiding clinical decisions. Early identification of patients unlikely to respond well to treatment could prompt early referral for interventions such as ventricular assist devices or heart transplantation, particularly considering the increasingly lengthy wait times for heart transplants. Consequently, efforts have been directed towards identifying predictors of Left Ventricular Reverse Remodeling (LVRR), a marker of treatment response strongly linked to prognosis.

DNA damage

Numerous potential predictors of LVRR have been proposed, ranging from hemodynamic parameters and chamber geometry to late gadolinium enhancement on magnetic resonance imaging and genetic variations. However, most studies have focused on specific underlying diseases, lacking validation across various etiologies. The absence of a universal predictor for heart failure across its diverse causes complicates accurate prognosis and the ability to determine appropriate treatment strategies in advance. Thus, despite strides in research, accurately predicting outcomes and tailoring treatments to individual patients with heart failure remains challenging. Numerous studies involving both humans and other animals have indicated the pivotal role of DNA damage in the onset of heart failure induced by pressure overload, dilated cardiomyopathy, and age-related cardiac conditions. Recent findings from our research, which examined endomyocardial biopsy samples from a limited number of patients with dilated cardiomyopathy, revealed that individuals with significant DNA damage in their cardiomyocytes may not respond effectively to drug therapies. Additionally, we found that immunostaining for DNA damage markers could potentially serve as a predictive tool for Left Ventricular Reverse Remodeling (LVRR). These findings suggest that DNA damage patterns may indicate irreversible damage and could serve as a promising prognostic indicator for heart failure, particularly in cases of dilated cardiomyopathy.

Medical services

In our latest investigation, we conducted immunofluorescence staining for DNA damage markers in endomyocardial biopsy samples obtained from 175 patients diagnosed with Heart Failure with Reduced Ejection Fraction (HFREF), stemming from various underlying causes. Specifically, we focused on two DNA damage markers: poly (ADP-ribose)(PAR) and γ-H2A.X. is produced by PAR polymerase in response to various forms of DNA damage, facilitating subsequent DNA damage responses such as repair mechanisms and programmed cell death. A detailed protocol has been outlined for the Heart Matters stepped wedge cluster randomised trial. The trial focuses on reperfusion therapies in Acute Coronary Syndrome (ACS), which have demonstrated significant improvements in survival rates, particularly when administered promptly. However, delays in accessing these therapies increase the risk of mortality, with every 30-minute delay posing a heightened risk. A key obstacle to optimal outcomes is the delay by patients in recognizing symptoms of ACS and seeking timely medical assistance. To address this, international recommendations advocate for public education initiatives aimed at enhancing ACS awareness, urging individuals to promptly contact Emergency Medical Services (EMS) for early intervention. Various strategies have been explored to enhance public awareness and encourage prompt treatment-seeking behaviors in ACS. Mass media campaigns, specifically those addressing psychological barriers and providing actionable plans, have shown promise in increasing knowledge and encouraging appropriate actions. Nonetheless, emerging evidence suggests that sustained exposure to such campaigns is crucial for long-term effectiveness. Notably, the National Heart Foundation of Australia (NHFA) conducted a 4-year campaign targeting middle-aged adults, which achieved extensive reach and resulted in improved symptom recognition among the general populace, along with encouraging treatment-seeking behaviors and reducing rates of Out-of-Hospital Cardiac Arrests (OHCA).

However, the campaign's impact on symptom awareness was short-lived, and its high cost proved unsustainable. In light of these findings, a more targeted approach is recommended, focusing on regions with high ACS prevalence rates and low levels of symptom awareness and treatment-seeking behaviors. This strategic targeting aims to optimize the effectiveness of interventions while also addressing concerns regarding cost sustainability.