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Ismail Z, Aboughdir M, Duric B, Kakar S, Chan JSK, Bayatpoor Y, Harky A. Advances in pharmacotherapy for heart failure and reduced ejection fraction: what's new in 2024? Expert Opin Pharmacother 2024; 25:1887-1902. [PMID: 39313997 DOI: 10.1080/14656566.2024.2408376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/04/2024] [Accepted: 09/20/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Updated guidelines for heart failure with reduced ejection fraction (HFrEF) and acute decompensation have improved outcomes, but ongoing efforts are focused on uncovering new evidence and developing novel therapies. This review examines the limitations of current treatments and the potential impact of emerging therapies. AREAS COVERED A literature search focused on studies investigating drugs for HFrEF. We review recent clinical trials and emerging therapies to assess evidence strength, explore guideline updates, and identify strategies to optimize patient outcomes. EXPERT OPINION The HFrEF treatment landscape is rapidly evolving, with advances in therapies like sodium/glucose cotransporter inhibitors and sacubitril-valsartan. Though managing acute decompensated heart failure remains challenging, recent trials suggest improvements in diuretic strategies and anti-inflammatory treatments. Ongoing research is essential for validating these therapies and incorporating them into standard practice.
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Affiliation(s)
- Zahra Ismail
- St. George's, University of London, Cranmer Terrace, London, UK
| | | | - Bea Duric
- GKT School of Medical Education, King's College London, London, UK
| | - Sahil Kakar
- University Hospitals Birmingham; Queen Elizabeth Hospital, Birmingham, UK
| | - Jeffrey Shi Kai Chan
- Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, United Kingdom-China Collaboration, Hong Kong, China
| | | | - Amer Harky
- Liverpool Heart and Chest Hospital, Liverpool, UK
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Falco L, Valente F, De Falco A, Barbato R, Marotta L, Soviero D, Cantiello LM, Contaldi C, Brescia B, Coscioni E, Pacileo G, Masarone D. Beyond Medical Therapy-An Update on Heart Failure Devices. J Cardiovasc Dev Dis 2024; 11:187. [PMID: 39057611 PMCID: PMC11277415 DOI: 10.3390/jcdd11070187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Heart failure (HF) is a complex and progressive disease marked by substantial morbidity and mortality rates, frequent episodes of decompensation, and a reduced quality of life (QoL), with severe financial burden on healthcare systems. In recent years, several large-scale randomized clinical trials (RCTs) have widely expanded the therapeutic armamentarium, underlining additional benefits and the feasibility of rapid titration regimens. This notwithstanding, mortality is not declining, and hospitalizations are constantly increasing. It is widely acknowledged that even with guideline-directed medical therapy (GDMT) on board, HF patients have a prohibitive residual risk, which highlights the need for innovative treatment options. In this scenario, groundbreaking devices targeting valvular, structural, and autonomic abnormalities have become crucial tools in HF management. This has led to a full-fledged translational boost with several novel devices in development. Thus, the aim of this review is to provide an update on both approved and investigated devices.
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Affiliation(s)
- Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
| | - Aldo De Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
| | - Raffaele Barbato
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
| | - Luigi Marotta
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
| | - Davide Soviero
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
| | - Luigi Mauro Cantiello
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
| | - Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
| | - Benedetta Brescia
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Enrico Coscioni
- Cardiac Surgery Division, AOU San Leonardo, 84100 Salerno, Italy;
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (F.V.); (A.D.F.); (R.B.); (L.M.); (D.S.); (L.M.C.); (C.C.); (G.P.)
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Manolis AA, Manolis TA, Manolis AS. Managing chronic coronary syndrome: how do we achieve optimal patient outcomes? Expert Rev Cardiovasc Ther 2024; 22:243-263. [PMID: 38757743 DOI: 10.1080/14779072.2024.2357344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Chronic coronary syndrome (CCS) remains the leading cause of death worldwide with high admission/re-admission rates. Medical databases were searched on CCS & its management. AREAS COVERED This review discusses phenotypes per stress-echocardiography, noninvasive/invasive testing (coronary computed-tomography angiography-CCTA; coronary artery calcium - CAC score; echocardiography assessing wall-motion, LV function, valvular disease; biomarkers), multidisciplinary management (risk factors/anti-inflammatory/anti-ischemic/antithrombotic therapies and revascularization), newer treatments (colchicine/ivabradine/ranolazine/melatonin), cardiac rehabilitation/exercise improving physical activity and quality-of-life, use of the implantable-defibrillator, and treatment with extracorporeal shockwave-revascularization for refractory symptoms. EXPERT OPINION CCS is age-dependent, leading cause of death worldwide with high hospitalization rates. Stress-echocardiography defines phenotypes and guides prophylaxis and management. CAC is a surrogate for atherosclerosis burden, best for patients of intermediate/borderline risk. Higher CAC-scores indicate more severe coronary abnormalities. CCTA is preferred for noninvasive detection of CAC and atherosclerosis burden, determining stenosis' functional significance, and guiding management. Combining CAC score with CCTA improves diagnostic yield and assists prognosis. Echocardiography assesses LV wall-motion and function and valvular disease. Biomarkers guide diagnosis/prognosis. CCS management is multidisciplinary: risk-factor management, anti-inflammatory/anti-ischemic/antithrombotic therapies, and revascularization. Newer therapies comprise colchicine, ivabradine, ranolazine, melatonin, glucagon-like peptide-1-receptor antagonists. Cardiac rehabilitation/exercise improves physical activity and quality-of-life. An ICD protects from sudden death. Extracorporeal shockwave-revascularization treats refractory symptoms.
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Affiliation(s)
| | - Theodora A Manolis
- Department of Psychiatry, Aiginiteio University Hospital, Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Ippokrateio University Hospital, Athens, Greece
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Masarone D, Lombardi C, Falco L, Coscioni E, Metra M. Recent Advances across the Spectrum of Heart Failure and Heart Transplant. J Clin Med 2024; 13:1427. [PMID: 38592320 PMCID: PMC10932249 DOI: 10.3390/jcm13051427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
In recent years, remarkable progress has been accomplished in the heart failure (HF) landscape, with novel drugs and groundbreaking device approaches [...].
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, AOS dei Colli-Monaldi Hospital, 80121 Naples, Italy;
| | - Carlo Lombardi
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (C.L.); (M.M.)
| | - Luigi Falco
- Heart Failure Unit, AOS dei Colli-Monaldi Hospital, 80121 Naples, Italy;
| | - Enrico Coscioni
- Cardiac Surgery Division, AOU San Leonardo, 84100 Salerno, Italy;
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (C.L.); (M.M.)
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Speranza-Sánchez M, Zavaleta E, Sancho-Zumbado S, Elizondo-Urrutia JC, Quirós-Romero A, Chaverri-Fernández J, García-Montero J, Arguedas-Chacón S. Dosing Challenges and Benefits of Vericiguat in a Patient With Decompensated Heart Failure: A Case Report. Cureus 2023; 15:e48065. [PMID: 38046500 PMCID: PMC10689053 DOI: 10.7759/cureus.48065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Vericiguat has emerged as a promising add-on therapy for decompensated heart failure with reduced ejection fraction (HFrEF) patients requiring hospitalization or IV diuretic administration. In the VICTORIA trial (Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction), vericiguat was demonstrated to significantly reduce mortality and hospitalization rates. However, the effect of vericiguat on patients receiving SGLT2 inhibitors remains uncertain. In this report, we present a complicated case of dilated heart failure receiving low doses of foundational therapy due to a patient's intolerance but still experiencing recurrent hospital readmissions. Following six months of low-dose vericiguat as an add-on therapy, the patient exhibited important improvements in various clinical parameters, including cardiac and renal function. Nonetheless, further investigation is crucial to substantiate the additional benefits of combination therapy. These findings provide further evidence for the potential benefits of vericiguat when treating HFrEF.
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