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Whats Trending in the Management of HF in 2017?

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Dr Ramachandra Barik, Hyderabad    05 January 2018

  1. There is a need to include new therapies which complement established pharmacological and device-based therapies in the treatment of patients with HF.
  2. The ACC, the AHA and the Heart Failure Society of America have updated treatment guidelines to incorporate two new pharmacological therapies for HFrEF: Sacubitril-valsartan and ivabradine.2
  3. The guidelines recommend that in patients with chronic symptomatic HFrEF NYHA Class II or III who tolerate an ACEI or ARB, replacement by ARNI (valsartan/sacubitril) will further reduce morbidity and mortality.2
  4. ARNI has shown to reduce the composite endpoint of CV death or HF hospitalization in an RCT comparing the first approved ARNI (valsartan/sacubitril) with enalapril in symptomatic patients with HFrEF tolerating an adequate dose of either ACEI or ARB.2
  5. Focused update on clinical guidelines recommend that ivabradine can be beneficial to reduce HF hospitalization for patients with symptomatic (NYHA Class II-III) stable chronic HFrEF (LVEF ≤35%) who are receiving GDEH, including a β-blocker at maximum tolerated dose and who are in sinus rhythm with a heart rate ≥70 bpm at rest.2
  6. Ivabradine is a new therapeutic agent that selectively inhibits the It current in the sinoatrial node, providing heart rate reduction.2
  7. The QUALIFY international registry has also shown that good adherence to pharmacologic treatment guidelines for ACEIs, ARBs, BBs, MRAs and ivabradine, with prescription of at least 50% of recommended dosages was associated with better clinical outcomes during the 5-month follow-up.
  8. Continuing global educational initiatives are imperative to emphasize and ensure the implementation of guidelines to optimize drug therapy and prescribing evidence-based doses in clinical practice.

References

  1. Huffman MD, et al. Natl Med J India. 2010;23(5):283-8. 2Yancy et al. Circulation. 2016;134:e282-e293. 3Komadja M, et al. Eur J Heart Failure. 2017;19(11):1414-23.

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