May 13, 2021Open Access
Timely and individualized heart failure management: need for implementation into the new guidelines
Key Result
Timely implementation of novel therapies, including SGLT2 inhibitors, vericiguat, and omecamtiv mecarbil, alongside established treatments, provides additive benefits in reducing mortality and hospitalizations in HFrEF.
Structured PICO
P
Population
Patients with heart failure with reduced ejection fraction (HFrEF)
I
Intervention
Guideline-directed medical therapy including SGLT2 inhibitors, ARNI, beta-blockers, MRAs, novel agents (vericiguat, omecamtiv mecarbil), IV iron, and device therapies (ICD, CRT, AF ablation)
Rapid and individualized implementation of foundational and novel HFrEF therapies is critical to maximize patient survival and reduce hospitalizations.
Limitations
- Concerns remain regarding patient selection and standardization of atrial fibrillation ablation procedures in heart failure patients.
- Regulatory approval and further clinical development for some novel agents like omecamtiv mecarbil remain uncertain.
Abstract
Abstract Due to remarkable improvements in heart failure (HF) management over the last 30 years, a significant reduction in mortality and hospitalization rates in HF patients with reduced ejection fraction (HFrEF) has been observed. Currently, the optimization of guideline-directed chronic HF therapy remains the mainstay to further improve outcomes for patients with HFrEF to reduce mortality and HF hospitalization. This includes established device therapies, such as implantable defibrillators and cardiac resynchronization therapies, which improved patients' symptoms and prognosis. Over the last 10 years, new HF drugs have merged targeting various pathways, such as those that simultaneously suppress the renin–angiotensin–aldosterone system and the breakdown of endogenous natriuretic peptides (e.g., sacubitril/valsartan), and those that inhibit the I f channel and, thus, reduce heart rate (e.g., ivabradine). Furthermore, the treatment of patient comorbidities (e.g., iron deficiency) has shown to improve functional capacity and to reduce hospitalization rates, when added to standard therapy. More recently, other potential treatment mechanisms have been explored, such as the sodium/glucose co-transporter inhibitors, the guanylate cyclase stimulators and the cardiac myosin activators. In this review, we summarize the novel developments in HFrEF pharmacological and device therapy and discuss their implementation strategies into practice to further improve outcomes.