Combination drug therapy in heart failure: greater than the sum of its parts

Abstract

This article refers to 'Incremental benefit of drug therapies for chronic heart failure with reduced ejection fraction: a network meta-analysis' by M. Komajda et al., published in this issue on pages 1315-1322.

First‐in‐man study of Heartech® percutaneous left ventricular partitioning device for treatment of heart failure postmyocardial infarction

“…Despite the fact that current pharmacological and mechanical therapeutic approaches did not substantially improve survival rates after hospitalizations due to HF, medications such as ß‐blockers, angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists remain key elements of HF therapy . In the present study, only a few patients did not receive standardized pharmacological therapeutics because of limited tolerance; all patients maintained appropriate heart rate and blood pressure throughout follow‐up.…”

“…ACEI, angiotensin-converting enzyme inhibitors; ARB, Angiotensin receptor blocker; CPET, peak oxygen consumption of cardiopulmonary exercise testing; CK-MB, creatine kinase-MB; cTNI, cardiac troponin I; DAPT = dual antiplatelet therapy; DBP, diastolic blood pressure; EQ-5D, European 5D health scale; LA, left atrial; LVEDVi, left ventricular end diastolic volume index; LVEF, left ventricular ejection fraction; LVESVi, left ventricular end-systolic volume index; Mitral E/e 0 ratio, mitral valve peak E-wave velocity/ mitral annular e 0 -wave velocity ratio; MV E/A ratio, mitral valve peak E-wave velocity/peak A-wave velocity ratio; NT-pro-BNP, N-terminal pro-brain natriuretic peptide; NYHA, New York Heart Association (classification); PASP, pulmonary artery systolic pressure; 6MWT, 6-min walk test; SBP, systolic blood pressure. blockers, and aldosterone antagonists remain key elements of HF therapy 6,26. In the present study, only a few patients did not receive standardized pharmacological therapeutics because of limited tolerance; all patients maintained appropriate heart rate and blood pressure throughout follow-up.…”

“…Various therapies have aimed to attenuate or reverse pathologic ventricular remodeling to improve functional status and outcomes in patients with HF post‐MI . Nevertheless, routine conventional therapies have had limited benefits in halting the progression of left ventricular dilation caused by increased ventricular volume and wall stress; for this reason, prognosis for HF patients post‐MI has been suboptimal.…”

“…Various therapies have aimed to attenuate or reverse pathologic ventricular remodeling to improve functional status and outcomes in patients with HF post-MI. 6 Nevertheless, routine conventional therapies have had limited benefits in halting the progression of left ventricular dilation caused by increased ventricular volume and wall stress; for this reason, prognosis for HF patients post-MI has been suboptimal. Whereas new strategies have been proposed with uncertain expectations, 7,8 mechanical reduction in left ventricular volume that lowers wall stress may prevent further ventricular remodeling in HF patients post-MI.…”

Rapid Repurposing of Novel Combination Drugs for the Treatment of Heart Failure via a Computationally Guided Network Screening Approach

“…Combination drugs with high efficacy and low adverse effects compared with single-agent therapies have been identified and widely applied for the treatment of complex diseases in the past decade. , Many efforts have been concentrated on the discovery of combination drugs against HF to improve therapeutic effects. − Valsartan–sacubitril is a first-in-class angiotensin receptor neprilysin inhibitor combination that has been used in HF treatment and was approved by the FDA in 2015 . Compared with enalapril, a commonly used single agent against HF, valsartan–sacubitril could reduce the risks of rehospitalization and mortality of HF patients, indicating that combination was a feasible therapy strategy …”