International Circulation: What do you think are the challenges we are going to face in treating heart failure in the near future?
　　《国际循环》：您认为在不久的将来我们在心力衰竭治疗中要面对的挑战是什么？
　　Prof Komajda: One is the ageing of the population with coexistent comorbidities which can complicate the treatment particularly in the case of renal dysfunction or pulmonary disease associated with heart failure because some of the drugs that we would like to use are more difficult to use in these situations. So ageing is one problem. Comorbidities are a second one， because they can be dependent on ageing of course. I think that a major issue for the future is heart failure with preserved ejection fraction because at the moment we have very little evidence-based indication that any treatment might be beneficial although we know that this is a growing proportion of the heart failure population due particularly to the ageing population. The major challenge that we will face will be the cost of hospitalization as it is a very important part of the overall economics of heart failure and we should try to find measures， either pharmacologically or otherwise， to substantially reduce hospitalizations in order to reduce the cost of heart failure. Another problem which is also important is polypharmacy. Heart failure is an area of polypharmacy because in low ejection fraction patients you are expected to provide a multitude of medications: beta-blockers and ACE inhibitors in addition to an ARB or aldosterone antagonist if heart failure persists and if there is a high heart rate， I believe that we will be providing ivabradine soon. So multiple medications in addition to other non-cardiovascular medications which makes for a long list and an expensive list for the patients.
　　Komajda教授：一个是有共存合并症人群的老龄化，这可使治疗复杂化，尤其是在肾功能不全或有与心力衰竭相关的肺部疾病的情况下，因为我们想用的某些药物在这些情况下更难以应用。因此，老龄化是一个问题。合并症是第二个问题，因为他们当然可能依赖于老龄化。我认为未来的一个重大问题是射血分数保留的心力衰竭，因为目前我们鲜有循证指征显示有任何可能有益的治疗，尽管我们知道心力衰竭人群所占比例在增加，尤其是由于人口老龄化。我们将面对的重大挑战将是住院费用，因为它是心力衰竭整体经济因素的一个非常重要的部分，我们应该设法从药理或其他方面寻找措施来大幅降低住院以减少心力衰竭花费。另一个也很重要的问题是多种药物合用。心力衰竭是一个多种药物合用的领域，因为在射血分数低的患者中，预计会被提供大量的药物：除ARB或醛固酮拮抗剂外，如果心力衰竭持续以及如果心率快，则还有β受体阻滞剂和ACE抑制剂，我相信我们将很快可以提供伊伐布雷定。因此，除了其他非心血管药物，还有多种药物，致使药物清单冗长，且对患者来说是一个昂贵的清单。