Heart failure – what’s new and what’s changed?

Abstract

Physicians responsible for the care of patients with heart failure due to left ventricular systolic dysfunction have access to a broad range of evidence-based treatments that prolong life and reduce symptoms. In spite of the significant progress made over the last four decades, there is an ongoing need for novel therapies to treat a condition that is associated with stubbornly high morbidity and mortality. In this article, we discuss the findings of SERVE-HF, a randomised controlled trial of adaptive servo-ventilation in patients with left ventricular systolic dysfunction, as well as EMPA-REG, a study of the effects of a novel diabetic agent that may be of greater interest to heart failure specialists than diabetologists. We also examine further analyses of the groundbreaking PARADIGM-HF trial, which attempt to answer some of the unresolved questions from the original study of the first combined angiotensin-receptor blocker and neprilysin inhibitor, sacubitril valsartan. The recently published National Institute for Health and Care Excellence guidelines for the management of acute heart failure and plans to introduce best practice tariffs bring into focus the need for wellorganised, multidisciplinary care. We discuss the challenges involved in developing and delivering a specialist service that meets the needs of a growing population of patients living with heart failure.

The ageing population in healthcare: a challenge to, and in, the workforce

“…These important areas are covered in detail within this edition in high quality and readable articles. [8][9][10] Maintaining our clinical knowledge and how we would like to receive CPD to support our practice is highlighted in a fascinating article from Ireland, 11 while the way we feed back to our trainees, via their online portfolios, could certainly be improved, especially in acute medical specialties, based on the evidence presented by Tham et al . 12 The pressure of time and the multiple demands placed on a stretched workforce certainly play into this, but we owe it to both our trainees and our patients to ensure we take In addition to the ageing and increasingly complex patient population described above, and the relentless pressure on the medical workforce, other government-driven agendas are also squeezing our senior and overseas colleagues.…”