Key result
Recent HFrEF advances highlight ivabradine, ARNIs, and the HeartMate 3 LVAD with no pump thrombosis.
Why the study?
Acute heart failure management remains challenging with limited benefit from many tested agents and ongoing questions about device therapy timing and need.
Recent advances have expanded HFrEF treatment options with ivabradine, ARNIs, and newer LVADs, while HFpEF management remains focused on symptom relief.
Answers are grounded in this paper and cite their sources.
Recent HF therapy advances update management options; leaves open optimal CRT/ICD timing pending further trials.
PURPOSE OF REVIEW: Acute heart failure continues to be a challenge as there is limited benefit of numerous agents that have been tested. Cardiac resynchronization therapy remains standard of care, yet timing and need for implantable cardiac defibrillator has been brought into question with the recent randomized trials. Several recent advances have been made towards management of heart failure both in drug and device therapy. The purpose of this review is to provide an update on the most important recent studies on heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). RECENT FINDINGS: Two new drugs have been added to the armamentarium for HFrEF; ivabradine and angiotensin receptor-neprilysin inhibitors (ARNIs). Initial data from a new left ventricular assist device (LVAD) pump, the HeartMate 3 (HM III), have demonstrated no reports of pump thrombosis at 6 months, but stroke and right ventricle failure continue to be a challenge with comparable rates compared with the HeartMate II. Several large studies in HFpEF failed to show improvement in outcomes and management continues to be geared towards lifestyle modification and symptom relief. SUMMARY: Newer therapies and devices have met with great success, yet there are several therapies that provide no benefit and even harm. A careful review of the recent literature remains instrumental to the effective management of patients with heart failure.
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Kassi et al. (2018) conducted a review in Heart failure with reduced and preserved ejection fraction. Newer therapies and devices (ivabradine, ARNIs, HeartMate 3 LVAD) was evaluated. Recent advances in heart failure management include the addition of ivabradine and ARNIs for HFrEF, and the HeartMate 3 LVAD which demonstrated no pump thrombosis at 6 months.
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