Acute heart failure treatment: a light at the end of the tunnel?

Cotter, Gad; Davison, Beth A.; Edwards, Christopher; Takagi, Koji; Cohen‐Solal, Alain; Mebazaa, Alexandre

doi:10.1002/ejhf.2116

Cited by 5 publications

(5 citation statements)

References 30 publications

(45 reference statements)

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“…Перспективные направления лечения хронической сердечной гемодинамики и клинического статуса больных с декомпенсированной сердечной недостаточностью, длительная терапия негликозидными инотропными стимуляторами может ассоциироваться с повышением риска смерти [12,86]. Светом в конце туннеля для пациентов с тяжелой сердечной недостаточностью, ассоциированной с низким сердечным выбросом и нестабильностью гемодинамики, у которых современные возможности фармакотерапии ограничены, может стать применение представителя нового класса миотропных соединений омекамтива мекарбила, являющегося селективным активатором сердечного миозина [87,88]. Post hoc анализ результатов рандомизированного клинического исследования GALACTIC-HF, в качестве первичной конечной точки в котором учитывались эпизод декомпенсации ХСН или сердечно-сосудистая смерть, продемонстрировал позитивное влияние омекамтива мекарбила на прогноз пациентов с тяжелой сердечной недостаточностью, соответствующей III и IV функциональному классу, и низкой ФВ ЛЖ (<30 %) [88].…”

Section: инотропные стимуляторыunclassified

Promising directions in the treatment of chronic heart failure: improving old or developing new ones?

et al. 2022

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Unprecedented advances of recent decades in clinical pharmacology, cardiac surgery, arrhythmology, and cardiac pacing have significantly improved the prognosis in patients with chronic heart failure (CHF). However, unfortunately, heart failure continues to be associated with high mortality. The solution to this problem consists in simultaneous comprehensive use in clinical practice of all relevant capabilities of continuously improving methods of heart failure treatment proven to be effective in randomized controlled trials (especially when confirmed by the results of studies in real clinical practice), on the one hand, and in development and implementation of innovative approaches to CHF treatment, on the other hand. This is especially relevant for CHF patients with mildly reduced and preserved left ventricular ejection fraction, as poor evidence base for the possibility of improving the prognosis in such patients cannot justify inaction and leaving them without hope of a clinical improvement in their condition. The lecture consistently covers the general principles of CHF treatment and a set of measures aimed at inotropic stimulation and unloading (neurohormonal, volumetric, hemodynamic, and immune) of the heart and outlines some promising areas of disease-modifying therapy.

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Section: инотропные стимуляторыunclassified

Promising directions in the treatment of chronic heart failure: improving old or developing new ones?

et al. 2022

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“…For decades, every study attempting to introduce a new intervention in this field showed neutral or negative findings. Only a few recent studies have presented promising results, indicating that sacubitril-valsartan, omecamtiv mecarbil and ferric carboxymaltose may be appropriate in this challenging clinical setting [49][50][51][52].…”

Section: Rationalementioning

confidence: 99%

Sodium-glucose Co-transporter 2 Inhibitors in Acute Heart Failure: A Review of the Available Evidence and Practical Guidance on Clinical Use

Morillas¹,

Galcerá²,

Alania³

et al. 2022

Rev. Cardiovasc. Med.

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Sodium-glucose co-transporter 2 (SGLT2) inhibitors were initially conceived as glucose-lowering agents. However, striking renal and cardiovascular benefits were observed in type 2 diabetes trials. This led to evaluate it in dedicated studies in chronic heart failure (HF) and chronic kidney disease, which also showed remarkable clinical results. Given this findings, and taking into account the multiple mechanisms of action, the use of SGLT2 inhibitors in acute heart failure seemed promising. Sotagliflozin was the first SGLT2 inhibitor to reduce heart failure hospitalizations within the acute setting in the SOLOIST-WHF trial. Only type 2 diabetes patients were included, with a preserved and reduced ejection fraction. In slightly less than half of the cohort, this medication was started when the diuretic therapy was transitioned from intravenous to oral, during the hospital admission. In the rest of the patients, sotagliflozin was started early after discharge. Empagliflozin proved to be safe, well-tolerated, increased diuresis, and reduced a combined clinical endpoint (worsening HF, rehospitalization for HF, or death at 60 days) when administered within the first 24 hours of an acute heart failure hospitalization in the EMPA-RESPONSE-AHF trial. More recently, empagliflozin showed a reduction in a composite primary endpoint of death, heart failure events, and quality of life compared to placebo in the EMPULSE trial. Empagliflozin was started after the initial stabilization phase, but while patients were still admitted and receiving intravenous loop diuretics. Less than half of the patients were diabetic and two-thirds had a left ventricular ejection fraction below 40%. Dapagliflozin is currently being tested in the DAPA ACT HF-TIMI 68 trial, which plans to enroll 2400 patients admitted with acute heart failure and reduced ejection fraction. We envision SGLT2 inhibitors as a useful tool in acute heart failure syndrome given the additive diuretic effect, and minimal impact on blood pressure, kidney function, and electrolytes. Its dosage schedule is simple and can help initiation and tolerance of other medical therapy. However, there is an increased risk of genital infections and euglycaemic ketoacidosis. Notwithstanding, once critically ill and fasting patients are excluded, early administration of SGLT2 inhibitors is safe. This review summarizes the development of SGLT2 inhibitors and the available evidence supporting their use during an acute heart failure admission. We also propose a practical guideline for in-hospital initiation and monitoring.

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“…Absent results of the ongoing STRONG-HF study [ 12 ] examining the effects of higher doses of RAASbs, BBs, and MRAs immediately after an AHF admission, in patients with a recent HF exacerbation, efforts should be made to optimize, as much as possible, therapy with known effective medications for HFREF. With regards to newer therapies, a few options should be considered [ 18 ].…”

Section: Recent Worsening Of Hfmentioning

confidence: 99%

Medical Therapy of Heart Failure with Reduced Ejection Fraction—A Call for Comparative Research

Cotter

Davison

Mebazaa

et al. 2021

JCM

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The armamentarium of therapies for patients with heart failure and reduced ejection fraction (HFREF) has increase substantially with the introduction of Angiotensin Receptor Neprilysin Inhibitor (ARNi), sodium glucose cotransport inhibitors (SGLTis), ivabradine, and Vericinguat, bringing to seven the number of potential therapies for HFREF. In the current review we highlight available data on the different classes of medications. Renin angiotensin blockers (RAASbs) and beta blockers (BBs) were shown to have very substantial effects in patients with HFREF. These medications are generic and hence relatively inexpensive. They have a 30-year track record of relatively benign short- and long-term safety profiles and should remain the cornerstone of therapy for patients with HFREF. ARNis are effective in further reducing adverse effects and should replace RAASbs in symptomatic HFREF patients, despite their relatively high prices. The addition of SGLTis (congested patients), Ivabradine (tachycardic patients), and Vericinguat (hypertensive patients) should be considered in patients who remain symptomatic despite optimal doses of RAASbs/ARNis, MRAs, and BBs. Comparative studies examining the efficacy of these medications, and strategies and prioritizing some over others should be considered as, given their similar side effects on heart rate, blood pressure, and renal function, it is highly unlikely that all can be given to the same patient.

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Acute heart failure treatment: a light at the end of the tunnel?

Cited by 5 publications

References 30 publications

Promising directions in the treatment of chronic heart failure: improving old or developing new ones?

Promising directions in the treatment of chronic heart failure: improving old or developing new ones?

Sodium-glucose Co-transporter 2 Inhibitors in Acute Heart Failure: A Review of the Available Evidence and Practical Guidance on Clinical Use

Medical Therapy of Heart Failure with Reduced Ejection Fraction—A Call for Comparative Research

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