The autonomic nervous system as a therapeutic target in heart failure: a scientific position statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology

Abstract

Despite improvements in medical therapy and device‐based treatment, heart failure (HF) continues to impose enormous burdens on patients and health care systems worldwide. Alterations in autonomic nervous system (ANS) activity contribute to cardiac disease progression, and the recent development of invasive techniques and electrical stimulation devices has opened new avenues for specific targeting of the sympathetic and parasympathetic branches of the ANS. The Heart Failure Association of the European Society of Cardiology recently organized an expert workshop which brought together clinicians, trialists and basic scientists to discuss the ANS as a therapeutic target in HF. The questions addressed were: (i) What are the abnormalities of ANS in HF patients? (ii) What methods are available to measure autonomic dysfunction? (iii) What therapeutic interventions are available to target the ANS in patients with HF, and what are their specific strengths and weaknesses? (iv) What have we learned from previous ANS trials? (v) How should we proceed in the future?

Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association

“…Imbalanced neuro‐endocrine activation and control of the myocardium and circulation is understood as a cornerstone of HF pathophysiology and a driving force of disease progression and high mortality of HF. Consequently, autonomic nervous system abnormalities have been a recent and exciting therapeutic target in HF . There are multiple cardiopulmonary reflexes that interact to keep blood pressure, heart rate, cardiac output, peripheral blood flow, fluid volume balance, ventilation, V/Q matching, arterial blood gases, and the metabolic state of the metabolizing tissues stable, even in illness, or during environmental or exertional stress ( Figure ) .…”

Recent advances in cardio‐oncology: a report from the ‘Heart Failure Association 2019 and World Congress on Acute Heart Failure 2019’

“…54 A secondary analysis of the data by Ridker et al 55 showed a reduction of lung cancer incidence (with 150 and 300 mg canakinumab vs. placebo) and lung cancer mortality (with 300 mg of canakinumab vs. placebo). These effects might be related to a sympathetic activation in some patients, like it has been shown for HF 60 . Dr Markus Anker (Berlin, Germany) discussed CV problems of cancer patients beyond anti-cancer therapy Cardio-oncology at Heart Failure Congress 2019 associated cardiotoxicity.…”

“…A recent analysis in 305 advanced colorectal adenoma patients suggested higher adenoma recurrence rates in those patients with higher heart rates 59 . These effects might be related to a sympathetic activation in some patients, like it has been shown for HF 60 . More studies are needed to better understand the underlying mechanisms.…”

Heart Failure Association position papers – a new way to advance the field

“…Other topical issues covered including cancer in HF by the cardio‐oncology sub‐committee, and a proposed taxonomy of heart and brain interactions complicating HF by the Heart and Brain Sub‐Committee as well as a practical guidance paper from the Study Group on Peripartum Cardiomyopathy . There were also important papers from our translational scientist colleagues, including one from the Translational Research Committee on the autonomic nervous system as a therapeutic target in HF, and two from the affiliated Working Group on Myocardial Function, one covering an integrative translational approach to study HFpEF and a second on the innate immune system in chronic cardiomyopathy . The HFA has never looked stronger.…”