scholarly journals Looking for a Tailored Therapy for Heart Failure: Are We Capable of Treating the Patient Instead of the Disease?

2021 ◽  
Vol 10 (19) ◽  
pp. 4325
Author(s):  
Alessandro Fucili ◽  
Paolo Cimaglia ◽  
Paolo Severi ◽  
Francesco Giannini ◽  
Alberto Boccadoro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Soluble Guanylate Cyclase ◽  
New Drugs ◽  
Reduced Ejection Fraction ◽  
Novel Treatments ◽  
Neprilysin Inhibitor ◽  
Angiotensin Receptor Neprilysin Inhibitor ◽  
Personalized Approach ◽  
Different Characteristics

After almost a decade of stagnation in clinical research for HF treatment, five large randomized trials recently published have supported the use of four new classes of drugs, namely: angiotensin receptor/neprilysin inhibitor, sodium–glucose co-transporters 2 inhibitors, soluble guanylate cyclase modulators, and myosin activators. Each treatment has proved to be beneficial for both long-term outcomes and quality of life. Beside their clinical relevance, all these novel treatments have a different mechanism of action beyond the usual neuro-hormonal blockage. These different pathways, together with the unquestionable clinical evidence, advocate a re-thinking of HF treatment and of the appropriate drug to integrate with the existing standard therapy, according to different characteristics of HFrEF patients. This study aimed to offer a synthetic overview of the mechanisms of action of the new drugs and to propose a more personalized approach, considering patients’ characteristics and safety profiles. To this end, we have identified seven profiles for patients with chronic heart failure with reduced ejection fraction and two for pre-discharge patients.

Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Long-Term Cardiac Mortality in Heart Failure with Reduced Ejection Fraction

Angiology ◽  
2021 ◽  
pp. 000331972110473
Author(s):  
Umut Karabulut ◽  
Kudret Keskin ◽  
Dilay Karabulut ◽  
Ece Yiğit ◽  
Zerrin Yiğit
Keyword(s):  
Heart Failure ◽  
Combination Therapy ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Mortality ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor

The angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II–IV symptoms and ejection fraction ≤40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16–3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) ( P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10–.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85–.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.

Shift of conventional paradigm of heart failure treatment: from angiotensin receptor neprilysin inhibitor to sodium–glucose co-transporter 2 inhibitors?

2021 ◽  
Vol 17 (3) ◽  
pp. 497-506
Author(s):  
Alexander E Berezin ◽  
Alexander A Berezin
Keyword(s):  
Heart Failure ◽  
Wide Spectrum ◽  
Large Body ◽  
Renin Angiotensin System ◽  
Angiotensin Receptor ◽  
Heart Failure Treatment ◽  
Angiotensin System ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Angiotensin Receptor Neprilysin Inhibitor

Current clinical guidelines for heart failure (HF) contain a brand new therapeutic strategy for HF with reduced ejection fraction (HFrEF), which is based on neurohumoral modulation through the use of angiotensin receptor neprilysin inhibitors. There is a large body of evidence for the fact that sodium-glucose co-transporter 2 inhibitors may significantly improve all-cause mortality, cardiovascular mortality and hospitalization for HF in patients with HFrEF who received renin–angiotensin system blockers including angiotensin receptor neprilysin inhibitors, β-blockers and mineralocorticoid receptor antagonists. The review discusses that sodium-glucose co-transporter 2 inhibitors have a wide spectrum of favorable molecular effects and contribute to tissue protection, improving survival in HFrEF patients.

scholarly journals New Drugs for the Treatment of Heart Failure

2017 ◽  
Vol 11 (2) ◽  
pp. 62 ◽  
Author(s):  
Amarinder Bindra ◽  
Shelley A Hall ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Sinoatrial Node ◽  
New Drugs ◽  
Common Denominator ◽  
Primary Endpoints ◽  
Neprilysin Inhibitor ◽  
Omecamtiv Mecarbil ◽  
Angiotensin Receptor Neprilysin Inhibitor ◽  
The Common ◽  
Relaxin Receptor

Angiotensin receptor-neprilysin inhibitor, Entresto® (Novartis), a combination of sacubitril and valsartan, and funny channel inhibitor of the sinoatrial node, Corlanor® (Amgen), are two new drugs that have been Food and Drug Association-approved for treatment of symptomatic heart failure patients. Their mechanisms of action differ from each other and from the heart failure drugs available prior to their approval. Reduction in mortality is the hallmark of Entresto, while reduction in hospitalizations was the common denominator of both Entresto and Corlanor. These drugs are generally well tolerated and are widely used by heart failure cardiologists. Another promising agent, omecamtiv mecarbil, a myosin activator, is currently under trials, while RLX030, a relaxin receptor agonist, did not meet primary endpoints in a study.

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