A year in heart failure: an update of recent findings

Abstract

Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin‐converting enzyme inhibitors or an angiotensin receptor‐neprilysin inhibitor, beta‐blockers, mineralocorticoid receptor antagonists, and sodium‐glucose co‐transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM‐AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo‐controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR‐Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer‐related HF, also occurred. Coronavirus disease 2019 (COVID‐19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.

Earlier is Better. New Options for Acute Heart Failure: When, Who, How Much?

“…[1] The risk is maximal for patients admitted with acute heart failure (AHF), reaching in-hospital mortality rates up to 10% and a composite of rehospitalisation and death rates around 30% at the one-year mark, depending on the series analysed. [2,3,4] New therapeutical options were made possible after the results of randomised trials with valsartan/sacubitril (Val/Sac) and SGLT₂ inhibitors were published. This has established solid proof of mortality reduction in both groups of patients with reduced and preserved ejection fraction (EF).…”

Heart failure: an update from the last years and a look at the near future

“…Sex‐based differences exist among patients with HF 14–19 . Women with known or suspected coronary artery disease are at a higher risk of new‐onset HF, 20 but they are generally older than men at the time of diagnosis, more frequently develop HFpEF, and seem to have a better prognosis than men, even after age adjustment 21,22 .…”

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

“…The overall prevalence of HF ranges from about 1.5% to 4% in developed countries. [1][2][3] The HFA Atlas survey, conducted in 2018-2019 in 42 ESC countries, reported that the median incidence of HF was 3.20 [interquartile range (IQR) 2.66-4.17] cases per 1000 person-years, ranging from 1.99 in Italy and Denmark to 6.55 cases per 1000 person-years in Germany. 2,6 Women showed a higher prevalence of HFpEF compared with men.…”