CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction

McDonald, Michael; Virani, Sean; Chan, Michael; Ducharme, Anique; Ezekowitz, Justin A.; Giannetti, Nadia; Heckman, George A.; Howlett, Jonathan G.; Koshman, Sheri L.; Lepage, Serge; Mielniczuk, Lisa; Moe, Gordon W.; O’Meara, Eileen; Swiggum, Elizabeth; Toma, Mustafa; Zieroth, Shelley; Anderson, Kim B.; Bray, Sharon; Clarke, Brian; Cohen‐Solal, Alain; D’Astous, Michel; Davis, Margot K.; De, Sabe; Grant, Andrew; Grzeslo, Adam; Heshka, Jodi; Keen, Sabina; Kouz, Simon; Lee, Douglas S.; Masoudi, Frederick A.; McKelvie, Robert S.; Parent, Marie-Claude; Poon, Stephanie; Rajda, Miroslaw; Sharma, Abhinav; Siatecki, Kyla; Storm, Kate; Sussex, Bruce; Spall, Harriette G.C. Van; Yip, Amelia

doi:10.1016/j.cjca.2021.01.017

Cited by 228 publications

(261 citation statements)

References 87 publications

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“…Overall, our results suggested that the safety with SV can be replicated outside the clinical trial context. Current heart failure guidelines (17)(18) recommended sex-neutral target dose recommendations for SV. The Food and Drug Act (2) did not provide any sex-specific recommendations for SV (apart from a warning of potential fetal toxicity in pregnant women and advised discontinuation of SV in breastfeeding women).…”

Section: Discussionmentioning

confidence: 99%

Real-World Safety of Sacubitril/Valsartan in Women and Men With Heart Failure and Reduced Ejection Fraction: A Meta-analysis

Nuechterlein

AlTurki

et al. 2021

CJC Open

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

Real-World Safety of Sacubitril/Valsartan in Women and Men With Heart Failure and Reduced Ejection Fraction: A Meta-analysis

Nuechterlein

AlTurki

et al. 2021

CJC Open

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“…Other HF medications should also be implemented promptly according to patient characteristics to improve outcomes [ 51 , 52 ]. This approach was already implemented in the new Canadian Cardiovascular Society HF guidelines update, which strongly recommended that HFrEF patients should be initially treated with combination therapy from each of the following categories (ARNI/ACEI, B-blocker, MRA and SGLT2 inhibitor) [ 53 ]. Other therapies should be individualized to subgroups based on clinical scenario (ICD/CRT, ivabradine in sinus rhythm above 70 beats/min, assist systems, heart transplantation, etc.).…”

Section: Should We Move To Individualized Rather Than Chronological Treatment Recommendation?mentioning

confidence: 99%

Timely and individualized heart failure management: need for implementation into the new guidelines

et al. 2021

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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 If 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.

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“…This result was driven by a reduction in HF hospitalizations [9]. Based on preliminary data, the prognostic benefit from vericiguat does not seem to be associated with reverse remodelling [45], contrary to sacubitril/valsartan [41]. The VICTORIA trial was underpowered to assess the effects of combined vericiguat and sacubitril/valsartan therapy.…”

Section: Future Perspectivesmentioning

confidence: 99%

“…Moreover, it must be pointed out that, compared to PARADIGM-HF and DAPA-HF, the VICTORIA trial enrolled more fragile patients (older, more symptomatic, with higher NP levels) who had recently recovered from an AHF event; therefore, vericiguat could be a valuable adjunct in this vulnerable group [9]. Accordingly, the recently published update of the Canadian Cardiovascular Society (HF) guidelines suggests considering vericiguat for HFrEF patients just recovered from HF hospitalization on top of a therapy including a beta-blocker, an ACEi/ARB/ ARNI, a MRA and a SGLT2i [45].…”

Section: Future Perspectivesmentioning

confidence: 99%

The place of vericiguat in the landscape of treatment for heart failure with reduced ejection fraction

et al. 2021

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The significant morbidity and mortality associated with heart failure with reduced (HFrEF) or preserved ejection fraction (HFpEF) justify the search for novel therapeutic agents. The nitric oxide (NO)–soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) pathway plays an important role in the regulation of cardiovascular function. This pathway is disrupted in HF resulting in decreased protection against myocardial injury. The sGC activator cinaciguat increases cGMP levels by direct, NO-independent activation of sGC, and may be particularly effective in conditions of increased oxidative stress and endothelial dysfunction, and then reduced NO levels, but this comes at the expense of a greater risk of hypotension. Conversely, sGC stimulators (riociguat and vericiguat) enhance sGC sensitivity to endogenous NO, and then exert a more physiological action. The phase 3 VICTORIA trial found that vericiguat is safe and effective in patients with HFrEF and recent HF decompensation. Therefore, adding vericiguat may be considered in individual patients with HFrEF, particularly those at higher risk of HF hospitalization; the efficacy of the sacubitril/valsartan-vericiguat combination in HFrEF is currently unknown.

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CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction

Cited by 228 publications

References 87 publications

Real-World Safety of Sacubitril/Valsartan in Women and Men With Heart Failure and Reduced Ejection Fraction: A Meta-analysis

Real-World Safety of Sacubitril/Valsartan in Women and Men With Heart Failure and Reduced Ejection Fraction: A Meta-analysis

Timely and individualized heart failure management: need for implementation into the new guidelines

The place of vericiguat in the landscape of treatment for heart failure with reduced ejection fraction

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