Highlights in heart failure

Abstract

Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

A comprehensive individual patient data meta‐analysis of the effects of cardiac contractility modulation on functional capacity and heart failure‐related quality of life

“…Despite this, few of the established HF therapies have been shown to improve either PROs or functional capacity. [1][2][3] Over the last two decades, device-based therapies such as left ventricular assist devices and cardiac resynchronization (CRT) have become established therapies for selected HF patients. Left ventricular assist device therapy remains restricted to a very small minority of severely affected advanced HF patients.…”

Predominant subtype of heart failure after acute myocardial infarction is heart failure with non‐reduced ejection fraction

“…Angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), beta‐blockers, and mineralocorticoid antagonists form the pillars of the current management of HFrEF 7 . However, no treatment has been shown to reduce mortality and morbidity in HFpEF 14 . Several cardiologists assume that most cases of HF that develop after AMI are classified as HFrEF because AMI affects the viable myocardium.…”

Muscle Wasting and Sarcopenia in Heart Failure—The Current State of Science

“…Consequently, the number of older HF patients with increasing clinical complexity is progressively growing [53]. As a result, a multimodal approach is needed, combining many different medical disciplines to treat non-cardiac co-morbidities such as wasting disorders [54] and to lead to an improvement of different secondary outcomes as well [55,56]. Muscle wasting is one of the main causes for exercise intolerance and ventilatory inefficiency in HF patients [57].…”