Heart failure (HF) is categorized into acute or chronic, and both settings are the focus of this report. While much progress has been made in the pharmacological management of HF, it mainly relates to chronic HF (CHF) with reduced ejection fraction (HFrEF); a significant unmet need remains for CHF with preserved ejection fraction (HFpEF). In addition, the treatment of acute HF (AHF) is dominated by older, generic products. This report provides insights into the continued uptake of Entresto and the potential of several new therapies for CHF (Boehringer Ingelheim/Eli Lilly’s Jardiance, AstraZeneca’s Farxiga, Bayer/MSD’s vericiguat, Amgen/Cytokinetics’s omecamtiv mecarbil, and Lexicon Pharmaceuticals’ Zynquista) over the 2018-2028 forecast period. In addition, we assess how the AHF market will evolve given the lack of new drug launches.

Questions Answered

  • How large is the treatable heart failure population and how will the size of the diagnosed population change over time?
  •  What is the state of treatment in heart failure? What are the most important drugs and why? What clinical needs remain unfulfilled?
  •  How will the use of Entresto evolve over the forecast period?
  •  How will the treatment of HFpEF evolve following the launches of the first evidence-based drugs for this population?
  •  For which emerging therapies do thought leaders express the most enthusiasm and what level of market penetration can they expect?


United States, France, Germany, Italy, Spain, United Kingdom, Japan

Table of contents

  • Disease Landscape & Forecast
    • COVID-19
    • Key Findings
      • Heart Failure Key Findings: December-2019
    • Key Updates
      • June 2020
      • February 2020
      • December 2019
      • September 2019
      • June 2019
    • Market Outlook
      • Key Findings
      • COVID-19: Areas of Potential Forecast Impact
      • Market Drivers and Constraints
        • What Factors Are Driving the Market for Heart Failure?
        • What Factors Are Constraining the Market for Heart Failure?
      • Drug-Class-Specific Trends
        • Loop Diuretics
        • Inotropic Sympathomimetics, Phosphodiesterase 3 Inhibitors, and Calcium Sensitizers
        • Natriuretic Peptide Receptor Agonists
        • ACE Inhibitors
        • AIIRA/ARBs
        • ARNI
        • HCN Channel Blockers
        • Mineralocorticoid Receptor Antagonists
        • Sodium-Glucose Cotransporter-2 Inhibitors
        • Soluble Guanylate Cyclase Stimulators
        • Cardiac Myosin Activators
    • Forecast
      • Market Forecast Assumptions - AHF (2018-2028) - February 2020
      • Market Forecast Assumptions - CHF (2018-2028) - December 2019
      • Market Forecast Dashboard - AHF (2018-2028) - February 2020
      • Market Forecast Dashboard - CHF (2018-2028) - December 2019
    • Etiology and Pathophysiology
      • Disease Overview
      • Etiology
      • Pathophysiology
      • Heart Failure Development
      • Heart Failure Stages
      • Key Pathways and Drug Targets
    • Epidemiology
      • Key Findings
      • Epidemiology Populations
        • Diagnosed Events of Acute Heart Failure
        • Diagnosed Prevalent Cases of Chronic Heart Failure
        • Diagnosed Prevalent Cases of Chronic Heart Failure by NYHA-Functional Classification Scheme
        • Diagnosed Prevalent Cases of Chronic Heart Failure by Ejection Fraction
        • Drug-Treated Prevalent Cases of CHF and Events of AHF
    • Current Treatment
      • Key Findings
      • Treatment Goals
      • Key Current Therapies
        • Overview
        • Loop Diuretics
        • Nitrate Vasodilators
        • Inotropic Sympathomimetics
        • Phosphodiesterase 3 Inhibitors
        • Natriuretic Peptide Receptor Agonists
        • Calcium Sensitizers
        • ACE Inhibitors
        • AIIRA/ARBs
        • ARNI
        • Beta Blockers
        • Mineralocorticoid Receptor Antagonists
        • Digitalis Glycosides
        • HCN Channel Blockers
        • Vasodilator Combination Therapies
        • Vasopressin Receptor Antagonists
      • Medical Practice
        • Overview
        • Region-Specific Treatment Practices
    • Unmet Need Overview
      • Current and Future Attainment of Unmet Needs in Heart Failure
    • Emerging Therapies
      • Key Findings
        • Key Findings
      • Key Emerging Therapies
        • Notable Developments Among Key Emerging Therapies for Heart Failure
        • Nitroxyl Donors
        • Luso-Inotropic Agents
        • Soluble Guanylate Cyclase Stimulators
        • Sodium-Glucose Cotransporter-2 Inhibitors
        • Cardiac Myosin Activators
        • Stem Cell Therapies
      • Early-Phase Pipeline Analysis
      • Key Discontinuations and Failures in Heart Failure
    • Access & Reimbursement Overview
      • Region-Specific Reimbursement Practices
        • United States
        • EU5
        • Japan
      • Looking for More?
    • Methodology
      • Bottom-Up Forecasting Overview
        • Patient Populations
        • Drug-Specific Assumptions
      • Bottom-Up Forecast Assumptions
        • General Sources of Data
        • Agents Included in Our Market Analysis
        • General Statements About Pricing
        • Dosing, Days of Therapy, and Compliance
        • Generic Erosion
        • Out-Year Forecasting
        • Emerging Therapy Prices
      • Primary Market Research
        • Experts Interviewed
    • Appendix
      • Heart Failure Bibliography

Author(s): Dominika Rudnicka-Noulin, PhD, MSc; Sunali D. Goonesekera, SM

Dominika Rudnicka-Noulin, PhD, MSc is a senior business insights analyst in the Cardiovascular, Metabolic and Renal division at Decision Resources Group, specializing in cardiovascular diseases, with expertise in heart failure and acute coronary syndrome. Prior to joining DRG, Dominika held a position of an associate editor at Nature Communications, working across a variety of therapy areas. Dominika also worked for three years as a Postdoctoral Research Associate on a joint project between Imperial College London and MedImmune aimed at developing more potent antibody-based drugs. Dominika gained her PhD at the Institut Pasteur in Paris, France where her work was funded by the European Commission Marie Skłodowska-Curie Actions

Sunali Goonesekera is an Associate Epidemiologist at Decision Resources Group. Sunali holds a Master’s degree in Epidemiology from the Harvard School of Public Health and a in Biology (Honors) from Dartmouth College. Prior to joining Decision Resources Group, Sunali conducted epidemiological research and lead authored two manuscripts on racial/ethnic disparities in metabolic diseases at the New England Research Institutes. She has contributed to multiple publications in peer-reviewed journals in epidemiology and in the biological sciences.

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