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

2021 ◽  
Vol 10 (9) ◽  
pp. 1803
Author(s):  
Gad Cotter ◽  
Beth A. Davison ◽  
Alexandre Mebazaa ◽  
Koji Takagi ◽  
Maria Novosadova ◽  
...  

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.

2021 ◽  
Author(s):  
Hyue Mee Kim ◽  
In-Chang Hwang ◽  
Wonsuk Choi ◽  
Yeonyee E. Yoon ◽  
Goo-Yeong Cho

Abstract Background Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose co-transporter-2 inhibitor (SGLT2i) have shown robust benefits in improving cardiac function and disease prognosis in diabetic patients with heart failure with reduced ejection fraction (HFrEF). However, their combined effect has not been revealed. Methods We retrospectively identified diabetic patients with HFrEF who were prescribed an ARNI and/or SGLT2i. Diabetic patients with HFrEF treated with standard HF therapy but not ARNI or SGLT2i were included as controls. The patients were divided into groups treated with both ARNI and SGLT2i (group 1), ARNI but not SGLT2i (group 2), SGLT2i but not ARNI (group 3), and neither ARNI nor SGLT2i (group 4). After propensity score-matching, the occurrence of hospitalization for heart failure (HHF), cardiovascular mortality, and changes in echocardiographic parameters were analyzed. Results Of the 206 matched patients included in the study, 90 (43.7%) had to undergo HHF and 43 (20.9%) died of cardiovascular causes during a median 25 months of follow-up. Patients in group 1 exhibited a lower risk of HHF and cardiovascular mortality compared to those in the other groups. Improvements in the left ventricular ejection fraction and mitral E/e’ were more pronounced in group 1 than in groups 2, 3 and 4. These echocardiographic improvements were more prominent after the initiation of ARNI, compare to the initiation of SGLT2i. Conclusion In diabetic patients with HFrEF, combination of ARNI and SGT2i showed significant improvement in cardiac function and prognosis. ARNI-SGLT2i combination therapy may improve the clinical course of HFrEF in diabetic patients.


Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Scott D Solomon ◽  
Milton Packer ◽  
Michael Zile ◽  
Jean Rouleau ◽  
Karl Swedberg ◽  
...  

Introduction: The angiotensin receptor neprilysin inhibitor LCZ696 reduced cardiovascular death, heart failure hospitalization and all-cause mortality in patients with heart failure and reduced ejection fraction compared with enalapril. Hypothesis: We hypothesized that LCZ696 would reduce 30-day readmission after a heart failure hospitalization. Methods: PARADIGM-HF randomized 8399 patients with HF and reduced ejection fraction to either LCZ696 200mg bid or Enalapril 10mg bid. We assessed the risk of 30-day readmission for any cause following investigator reported and adjudicated hospitalization for heart failure. Admission and discharge dates were available for 2800 hospitalizations (95%) in 1638 patients. Results: Of 2800 HF hospitalizations, 1545 occurred in 871 patients in the enalapril group and 1255 occurred in 767 patients in the LCZ arm. Overall, 10.5% of these HF hospitalizations were followed by a repeat hospitalization for any cause within 30 days of discharge, and this occurred significantly less frequently in the LCZ arm (8.7%) relative to the enalapril arm (12.0%), in both unadjusted models and a random-effects logistic regression model accounting for the repeated HF hospitalizations experienced by some patients. We observed similar results in a sensitivity analysis restricted only to the first HF hospitalization for each patient. Further adjustment for baseline characteristics did not alter these findings. Similar effect sizes were observed for adjudicated heart failure hospitalizations. Conclusion: In patients admitted with heart failure in PARADIGM-HF, LCZ reduced 30-day readmissions for any-cause.


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