Heart failure can affect everyone: the ESC Geoffrey Rose lecture
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Updated: Dec 27, 2025
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Karen Sliwa1,2,3
1Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, 3 Anzio road, Observatory 7925, Cape Town, South Africa.
Insights
Heart failure (HF) affects all populations, not just the elderly. Addressing widespread risk factors is crucial for global health, moving beyond individual-focused treatments.
Area of Science:
- Cardiology
- Public Health
Background:
- The Geoffrey Rose concept of 'sick individuals vs. sick population' remains relevant for understanding heart failure (HF).
- HF is a global health issue affecting diverse demographics, not solely the elderly.
- Complex pathways, including risk factors, socioeconomic status, and healthcare access, contribute to HF prevalence.
Purpose of the Study:
- To re-evaluate the applicability of Geoffrey Rose's population health principles to contemporary heart failure.
- To emphasize the global burden of heart failure across all age groups and genders.
- To advocate for a shift in focus from individual high-risk interventions to population-level risk factor management.
Main Methods:
- This article is a perspective piece, expanding on a lecture presented at the European Society of Cardiology meeting (2019).
- It synthesizes existing knowledge on heart failure epidemiology and risk factors.
- It reflects on the principles of population health in the context of heart failure.
Main Results:
- Heart failure affects a broad demographic spectrum globally, irrespective of age or gender.
- Multiple interconnected factors contribute to HF, including communicable diseases, environmental exposures, poverty, and healthcare inequities.
- Current approaches may overemphasize targeting high-risk individuals rather than addressing population-wide risk distribution.
Conclusions:
- A population-level approach is essential for effectively managing heart failure globally.
- Addressing socioeconomic determinants and widespread risk factors is critical for reducing the burden of HF.
- Global health strategies must evolve to incorporate population-wide interventions for heart failure prevention and management.
Abstract:
The principle of 'sick individuals vs. sick population', a concept pioneered by Geoffrey Rose 35 years ago, is particularly applicable to heart failure (HF). This perspective article summarizes and expands on the Geoffrey Rose lecture given at the European Society of Cardiology meeting held in conjunction with the World Congress of Cardiology, in Paris, 2019. This article focuses on the fact that, clearly, HF not only affects a large spectrum of the population globally, but it occurs in all ages and equally in both genders. Heart failure, in most parts of the world, is clearly not a disease of the elderly. There are multiple and complex pathways leading to HF which include various risk factors (including communicable diseases and exposure to indoor and environmental pollutants), poverty and overcrowding, as well as sub-optimal access to health care systems due to socioeconomic inequities. Reflecting on Geoffrey Rose's concept 35 years later motivates us to confront our global responsibility to address the population distribution of risk factors more effectively, instead of focusing solely on interventions that target high-risk individuals.
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