Advances in management of heart failure

Heidenreich, Paul; Sandhu, Alexander

doi:10.1136/bmj-2023-077025

BMJ

2024

DOI: 10.1136/bmj-2023-077025

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Advances in management of heart failure

Paul Heidenreich,

Alexander Sandhu

Abstract: Heart failure is increasing in prevalence in many countries with aging populations. Fortunately, remarkable scientific advances have been made in the past few years that have led to new treatments and improved prognosis for patients with heart failure. This review examines these changes with a focus on the diagnosis and medical management of heart failure. The changes include the increase to four foundational drug classes (pillars of therapy) now recommended for patients with heart failure and reduced left ven… Show more

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2024

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Cited by 2 publications

References 180 publications

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SGLT-2 inhibitors and mortality among patients with heart failure with reduced ejection fraction: linked database study

Svanström,

Mkoma,

Hviid

et al. 2024

BMJ

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Objective To investigate the association between sodium-glucose cotransporter-2 (SGLT-2) inhibitor use and risk of all cause mortality among patients with heart failure with reduced ejection fraction. Design Linked database study. Setting National registers in Denmark, July 2020 to June 2023. Participants Patients with heart failure, aged ≥45 years, with left ventricular ejection fraction ≤40%. Main outcome measures The primary outcome was all cause mortality comparing initiation and continued treatment with SGLT-2 inhibitors versus continued treatment with other standard-of-care heart failure drugs and non-use of SGLT-2 inhibitors; secondary outcomes were the composite of cardiovascular mortality or admission to hospital with heart failure and its individual components. Hazard ratios were estimated using Cox regression adjusted using inverse probability of treatment weighting based on propensity scores. Results The study included 6776 patients who started SGLT-2 inhibitors (79% dapagliflozin; 21% empagliflozin) and 14 686 patients who remained on other standard-of-care heart failure drugs and did not use SGLT-2 inhibitors. Most SGLT-2 inhibitor users were male (70%), the mean age was 71.2 (standard deviation 10.6) years, and 20% had type 2 diabetes. During follow-up, 374 deaths occurred among SGLT-2 inhibitor users (incidence rate 5.8 per 100 person years) and 1602 among non-users (8.5 per 100 person years). The weighted hazard ratio for all cause mortality was 0.75 (95% confidence interval 0.66 to 0.85); the weighted incidence rate difference was −1.6 (95% confidence interval −2.5 to −0.8) per 100 person years. Secondary outcomes showed a weighted hazard ratio of 0.94 (0.85 to 1.04) for cardiovascular mortality or hospital admission with heart failure, 0.77 (0.64 to 0.92) for cardiovascular mortality, and 1.03 (0.92 to 1.15) for hospital admission with heart failure. The weighted hazard ratios for all cause mortality were consistent in patients with and without diabetes (0.73 (0.58 to 0.91) and 0.73 (0.63 to 0.85); P=0.99). Conclusions In this large database study among patients with heart failure with reduced ejection fraction, SGLT-2 inhibitor use was associated with a 25% lower risk of all cause mortality, supporting their effectiveness in routine clinical practice.

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SGLT-2 inhibitors and mortality among patients with heart failure with reduced ejection fraction: linked database study

Svanström,

Mkoma,

Hviid

et al. 2024

BMJ

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show abstract

Estimating Time-to-Death and Determining Risk Predictors for Heart Failure Patients: Bayesian AFT Shared Frailty Models with the INLA Method

Ashine,

Tadesse Likassa,

Chen

2024

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Heart failure is a major global health concern, especially in Ethiopia. Numerous studies have analyzed heart failure data to inform decision-making, but these often struggle with limitations to accurately capture death dynamics and account for within-cluster dependence and heterogeneity. Addressing these limitations, this study aims to incorporate dependence and analyze heart failure data to estimate survival time and identify risk factors affecting patient survival. The data, obtained from 497 patients at Jimma University Medical Center in Ethiopia were collected between July 2015 and January 2019. Residence was considered as the clustering factor in the analysis. We employed the Bayesian accelerated failure time (AFT), and Bayesian AFT shared gamma frailty models, comparing their performance using the Deviance Information Criterion (DIC) and Watanabe–Akaike Information Criterion (WAIC). The Bayesian log-normal AFT shared gamma frailty model had the lowest DIC and WAIC, with well-capturing cluster dependency that was attributed to unobserved heterogeneity between patient residences. Unlike other methods that use Markov-Chain Monte-Carlo (MCMC), we applied the Integrated Nested Laplace Approximation (INLA) to reduce computational load. The study found that 39.44% of patients died, while 60.56% were censored, with a median survival time of 34 months. Another interesting finding of this study is that adding frailty into the Bayesian AFT models boosted the performance in fitting the heart failure dataset. Significant factors reducing survival time included age, chronic kidney disease, heart failure history, diabetes, heart failure etiology, hypertension, anemia, smoking, and heart failure stage.

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Advances in management of heart failure

Cited by 2 publications

References 180 publications

SGLT-2 inhibitors and mortality among patients with heart failure with reduced ejection fraction: linked database study

SGLT-2 inhibitors and mortality among patients with heart failure with reduced ejection fraction: linked database study

Estimating Time-to-Death and Determining Risk Predictors for Heart Failure Patients: Bayesian AFT Shared Frailty Models with the INLA Method

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