The ABCs of managing systolic heart failure: Past, present, and future

Okwuosa, Ike S.; Princewill, Oluseyi; Nwabueze, Chiemeke; Mathews, Lena; Hsu, Steven; Gilotra, Nisha A.; Lewsey, Sabra C.; Blumenthal, Roger S.; Russell, Stuart D.

doi:10.3949/ccjm.83a.16006

Cited by 8 publications

(7 citation statements)

References 57 publications

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“…Preventive efforts would target patients with ACC/AHA stage A heart failure-those at high risk for developing but currently without evidence of structural heart disease or heart failure symptoms ( Table 1). 7 This group may represent up to one-third of the US adult population, or 75 million people, when including the well-recognized risk factors of coronary artery disease, hypertension, diabetes mellitus, and chronic kidney disease in those without left ventricular dysfunction or heart failure. 8…”

Section: ■ Common Costly and Debilitatingmentioning

confidence: 99%

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Heart failure guidelines: What you need to know about the 2017 focused update

Haselhuhn

Brotman

Wittstein

2019

CCJM

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The 2017 focused update of the 2013 ACC/AHA guideline on heart failure contains new and important recommendations on prevention, novel biomarker uses, heart failure with preserved ejection fraction (HFpEF), and comorbidities such as hypertension, iron deficiency, and sleep-disordered breathing. Potential implications for management of acute decompensated heart failure will also be explored. KEY POINTSDespite advances in treatment, heart failure remains highly morbid, common, and costly. Prevention is key.Strategies to prevent progression to clinical heart failure in high-risk patients include new blood pressure targets (< 130/80 mm Hg) and B-type natriuretic peptide screening to prompt referral to a cardiovascular specialist.An aldosterone receptor antagonist might be considered to decrease hospitalizations in appropriately selected stage C HFpEF patients. Routine use of nitrates or phosphodiesterase-5 inhibitors in such patients is not recommended.Outpatient intravenous iron infusions are reasonable in persistently symptomatic New York Heart Association stage II to III heart failure with reduced ejection fraction (HFrEF) to improve functional capacity and quality of life.The new systolic blood pressure target is less than 130 mm Hg for stage A heart failure, stage C HFrEF, and stage C HFpEF.

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Section: ■ Common Costly and Debilitatingmentioning

confidence: 99%

“…The first half of the focused update 3 of the 2013 guidelines, 2 reviewed by Okwuosa et al, 7 provided recommendations for the use of sacubitril-valsartan, an angiotensin-neprilysin inhibitor (ARNI), and ivabradine, a selective sinoatrial node If channel inhibitor, in chronic HFrEF.…”

Section: Should Arnis and Ivabradine Be Started During Adhf Admissions?mentioning

confidence: 99%

Heart failure guidelines: What you need to know about the 2017 focused update

Haselhuhn

Brotman

Wittstein

2019

CCJM

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“…A starting dose of 49 mg sacubitril/ 51 mg valsartan twice daily is recommended after a 36 hour ACEI washout period (2). At a follow-up appointment in two to four weeks from initiation, the dose can be increased to the target dose of 97 mg of sacubitril/ 103 mg valsartan twice daily barring any side effects (8). If patients were not on optimal ACEI/ARB therapy prior to starting ARNI therapy, or were on a low ACEI/ARB dose, then it is recommended to start at 24 mg sacubitril/ 26 mg valsartan twice daily (2).…”

Section: Clinical Use Of Sacubitril/valsartan How Can Hospitalists Usmentioning

confidence: 99%

“…Sacubitril/valsartan use should be avoided in patients with a history of angioedema (3). Moreover, for patients on ACEI therapy that are switching to ARNI therapy it is recommended to have a 36-hour washout period to prevent this lifethreatening angioedema (3,8).…”

Section: Fda Dosing Guidelinesmentioning

confidence: 99%

Sacubitril/valsartan Use for the Hospitalist

Padkins¹,

Hart²,

Littrell³

2017

Am J Hosp Med

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“…Blocking the neurohumoral axis at different levels has shown some therapeutic success [ 10 ]. For example, significant improvements of morbidity and mortality have been obtained with angiotensin-converting enzyme inhibitors (ACEi), angiotensin-receptor blockers (ARB), β-blockers (BB) and mineralocorticoid receptor antagonists (MRA) [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiac myosin activators for heart failure therapy: focus on omecamtiv mecarbil

Kaplinsky¹,

Mallarkey²

2018

DIC

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Heart failure continues to be a major global health problem with a pronounced impact on morbidity and mortality and very limited drug treatment options especially with regard to inotropic therapy. Omecamtiv mecarbil is a first-in-class cardiac myosin activator, which increases the proportion of myosin heads that are tightly bound to actin and creates a force-producing state that is not associated with cytosolic calcium accumulation. Phase I and phase II studies have shown that it is safe and well tolerated. It produces dose-dependent increases in systolic ejection time (SET), stroke volume (SV), left ventricular ejection fraction (LVEF), and fractional shortening. In the ATOMIC-AHF trial, intravenous (IV) omecamtiv mecarbil did not improve dyspnoea overall but may have improved it in a high-dose group of acute heart failure patients. It did, however, increase SET, decrease left ventricular end-systolic diameter, and was well tolerated. The COSMIC-HF trial showed that a pharmacokinetic-based dose-titration strategy of oral omecamtiv mecarbil improved cardiac function and reduced ventricular diameters compared to placebo and had a similar safety profile. It also significantly reduced plasma N-terminal-pro B-type natriuretic peptide compared with placebo. The GALACTIC-HF trial is now underway and will compare omecamtiv mecarbil with placebo when added to current heart failure standard treatment in patients with chronic heart failure and reduced LVEF. It is expected to be completed in January 2021. The ongoing range of preclinical and clinical research on omecamtiv mecarbil will further elucidate its full range of pharmacological effects and its clinical usefulness in heart failure.

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The ABCs of managing systolic heart failure: Past, present, and future

Cited by 8 publications

References 57 publications

Heart failure guidelines: What you need to know about the 2017 focused update

Heart failure guidelines: What you need to know about the 2017 focused update

Sacubitril/valsartan Use for the Hospitalist

Cardiac myosin activators for heart failure therapy: focus on omecamtiv mecarbil

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