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Current Pharmacological Therapies in Heart Failure Patients

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Abstract

Heart failure (HF) is a major problem of public health. More than 23 million patients worldwide are affected by heart failure. Despite incidence and prevalence of heart failure may vary according to real world or randomized trials database, advancing age is a major determinant of heart failure. Heart failure is also characterized by an elevated rate of morbidity and mortality and represents one of the leading causes of hospitalization. A major consequence of heart failure is the frequent hospital admissions and related costs. Guidelines have clearly indicated evidence-based treatments in patients with heart failure, and the adherence to these indications has translated in an improvement of patient’s prognosis. Nevertheless, the use of recommended treatments at the recommended dosages is still lower than expected. In the last year in Europe new guidelines on the diagnosis and treatment of heart failure and in USA an update on pharmacological treatment of heart failure were published, pointing the attention on the use of new available pharmacological and non-pharmacological treatments. HF syndrome reflects the interaction between hemodynamic dysregulation (alterations in myocardial preload, afterload, and contractility and a neurohormonal disarray those results in the development of symptoms and in the progression of the disease. Current treatment approaches target both hemodynamic alterations and the neurohumoral elements to slow disease progression as well as to improve symptoms and outcomes.

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References

  1. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8:30–41.

    Article  PubMed  Google Scholar 

  2. Roger VL. Epidemiology of heart failure. Circ Res. 2013;113:646–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Ambrosy AP, Fonarow GC, Butler J, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol. 2014;63(12):1123–33.

    Article  PubMed  Google Scholar 

  4. Corrao G, Ghirardi A, Ibrahim B, Merlino L, Maggioni AP. Burden of new hospitalization for heart failure: a population-based investigation from Italy. Eur J Heart Fail. 2014;16:729–36.

    Article  PubMed  Google Scholar 

  5. Maggioni AP, Orso F, Calabria S, Rossi E, Cinconze E, Baldasseroni S, Martini N, ARNO Observatory. The real-world evidence of heart failure: findings from 41,413 patients of the ARNO database. Eur J Heart Fail. 2016;18(4):402–10.

    Article  PubMed  Google Scholar 

  6. Hopper I, Skiba M, Windebank E, Brack J, Tonkin A, Krum H. Polypharmacy in heart failure—Is reducing medication safe? Int J Cardiol. 2016;1(214):529–30.

    Article  Google Scholar 

  7. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM,Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force Members. Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129–2200.

  8. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos G, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2016 ACC/AHA/ HFSA Focused Update on New Pharmacological Therapy for Heart Failure: an update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2016;68:1476–88.

    Article  PubMed  Google Scholar 

  9. Antman EM, Bax J, Chazal RA, Creager MA, Filippatos G, Halperin JL, Houser S, Lindenfeld J, Pinto FJ, Vardas P, Walsh NM, Williams KA, Zamorano JL. Updated clinical practice guidelines on heart failure: an international alignment. Eur Heart J. 2016;37:2096.

    Article  PubMed  Google Scholar 

  10. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348:2007–18.

    Article  PubMed  Google Scholar 

  11. The CONSENSUS trial study group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316:1429–35.

  12. The SOLVD investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302.

  13. The SOLVD investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992; 327:685–91.

  14. Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE investigators. N Engl J Med. 1992;327:669–77.

    Article  CAS  PubMed  Google Scholar 

  15. Deedwania PC, Carbajal E. Evidence-based therapy for heart failure. Med Clin N Am. 2012;96:915–31.

    Article  CAS  PubMed  Google Scholar 

  16. Granger CB, McMurray JJ, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-alternative trial. Lancet. 2003;362:772–6.

    Article  CAS  PubMed  Google Scholar 

  17. Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003;349:1893–906.

    Article  CAS  PubMed  Google Scholar 

  18. Cohn JN, Tognoni G, Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med. 2001;345:1667–75.

    Article  CAS  PubMed  Google Scholar 

  19. McMurray JJ, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-added trial. Lancet. 2003;362:767–71.

    Article  CAS  PubMed  Google Scholar 

  20. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341:709–17.

    Article  CAS  PubMed  Google Scholar 

  21. Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309–21.

    Article  CAS  PubMed  Google Scholar 

  22. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364:11–21.

    Article  CAS  PubMed  Google Scholar 

  23. McMurray JJ, Krum H, Abraham WT, Dickstein K, Køber LV, Desai AS, Solomon SD, Greenlaw N, Ali MA, Chiang Y, Shao Q, Tarnesby G, Massie BM, ATMOSPHERE Committees Investigators. Aliskiren, enalapril, or aliskiren and enalapril in HEART failure. N Engl J Med. 2016;374:1521–32.

    Article  CAS  PubMed  Google Scholar 

  24. McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993–1004.

    Article  PubMed  Google Scholar 

  25. Jhund PS, Fu M, Bayram E, Chen CH, Negrusz-Kawecka M, Rosenthal A, Desai AS, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR, McMurray JJ, Packer M, PARADIGM-HF Investigators and Committees. Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HF. Eur Heart J. 2015;36:2576–84.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Solomon SD, Claggett B, Desai AS, Packer M, Zile M, Swedberg K, Rouleau JL, Shi VC, Starling RC, Kozan Ö, Dukat A, Lefkowitz MP, McMurray JJ. Influence of ejection fraction on outcomes and efficacy of sacubitril/valsartan (LCZ696) in heart failure with reduced ejection fraction: the Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) Trial. Circ Heart Fail. 2016;9:e002744.

    Article  CAS  PubMed  Google Scholar 

  27. Desai AS, McMurray JJ, Packer M, Swedberg K, Rouleau JL, Chen F, Gong J, Rizkala AR, Brahimi A, Claggett B, Finn PV, Hartley LH, Liu J, Lefkowitz M, Shi V, Zile MR, Solomon SD. Effect of the angiotensin-receptor-neprilysin inhibitor LCZ696 compared with enalapril on mode of death in heart failure patients. Eur Heart J. 2015;36:1990–7.

    Article  CAS  PubMed  Google Scholar 

  28. Simpson J, Jhund PS, Silva Cardoso J, Martinez F, Mosterd A, Ramires F, Rizkala AR, Senni M, Squire I, Gong J, Lefkowitz MP, Shi VC, Desai AS, Rouleau JL, Swedberg K, Zile MR, McMurray JJ, Packer M, Solomon SD, PARADIGM-HF Investigators and Committees. Comparing LCZ696 with enalapril according to baseline risk using the MAGGIC and EMPHASIS-HF risk scores. An analysis of mortality and morbidity in PARADIGM-HF. J Am Coll Cardiol. 2015;66:2059–71.

    Article  CAS  PubMed  Google Scholar 

  29. Okumura N, Jhund PS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Swedberg K, Zile MR, Solomon SD, Packer M, McMurray JJ, PARADIGM-HF Investigators and Committees. Effects of sacubitril/valsartan in the PARADIGMHF Trial (Prospective comparison of ARNI with ACEI to Determine impact on global mortality and morbidity in heart failure) according to background therapy. Circ Heart Fail. 2016;9:pii: e003212.

  30. Desai AS, Vardeny O, Claggett B, McMurray JJ, Packer M, Swedberg K, Rouleau JL, Zile MR, Lefkowitz M, Shi V, Solomon SD. Reduced risk of hyperkalemia during treatment of heart failure with mineralocorticoid receptor antagonists by use of sacubitril/valsartan compared with enalapril: a secondary analysis of the PARADIGM-HF trial. JAMA Cardiol. 2016. doi:10.1001/jamacardio.2016.4733 ([Epub ahead of print] PubMed PMID: 27842179).

  31. Solomon SD, Zile M, Pieske B, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet. 2012;380(9851):1387–95.

    Article  CAS  PubMed  Google Scholar 

  32. Packer M, Bristow MR, Cohn JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med. 1996;334:1349–55.

    Article  CAS  PubMed  Google Scholar 

  33. The cardiac insufficiency bisoprolol study II. (CIBISII): a randomised trial. Lancet. 1999;353:9–13.

    Article  Google Scholar 

  34. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT-HF). Lancet. 1999;353:2001–7.

    Article  Google Scholar 

  35. Packer M, Coats AJ, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001;344:1651–8.

    Article  CAS  PubMed  Google Scholar 

  36. Poole-Wilson PA, Swedberg K, Cleland JG, et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the carvedilol or metoprolol european trial (COMET): randomised controlled trial. Lancet. 2003;362:7–13.

    Article  CAS  PubMed  Google Scholar 

  37. Flather MD, Shibata MC, Coats AJS, Van Veldhuisen DJ, Parkhomenko A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat P, Soler-Soler J, Tavazzi L, Spinarova L, Toman J, Böhm M, Anker SD, Thompson SG, Poole-Wilson PA, SENIORS Investigators. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J. 2005;26:215–25.

    Article  CAS  PubMed  Google Scholar 

  38. Kotecha D, Holmes J, Krum H, Altman DG, Manzano L, Cleland JGF, Lip GYH, Coats AJS, Andersson B, Kirchhof P, von Lueder TG, Wedel H, Rosano G, Shibata MC, Rigby A, Flather MD. Efficacy of b blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet. 2014;384:2235–43.

    Article  CAS  PubMed  Google Scholar 

  39. Swedberg K, Komajda M, Bohm M, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 2010;376:875–85.

    Article  CAS  PubMed  Google Scholar 

  40. Swedberg K, Komajda M, Bohm M, et al. Effects on outcomes of heart rate reduction by ivabradine in patients with congestive heart failure: is there an influence of beta-blocker dose?: findings from the SHIFT (Systolic Heart Failure Treatment with the I(f) Inhibitor Ivabradine Trial) study. J Am Coll Cardiol. 2012;59:1938–45.

    Article  CAS  PubMed  Google Scholar 

  41. Rimoldi SF, Messerli FH, Cerny D, et al. Selective heart rate reduction with ivabradine increases central blood pressure in stable coronary artery disease. Hypertension. 2016;67:1205–10.

    Article  CAS  PubMed  Google Scholar 

  42. van Veldhuisen DJ, Cohen-Solal A, Böhm M, Anker SD, Babalis D, Roughton M, Coats AJS, Poole-Wilson PA, Flather MD. Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction. J Am Coll Cardiol. 2009;53:2150–8.

    Article  PubMed  Google Scholar 

  43. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJV, Michelson EL, Olofsson B, Ostergren J. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003;362:777–81.

    Article  CAS  PubMed  Google Scholar 

  44. Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB, Kitzman DW, Love TE, Aronow WS, Adams KF, Gheorghiade M. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation. 2006;114:397–403.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Mulder BA, van Veldhuisen DJ, Crijns HJGM, Böhm M, Cohen-Solal A, Babalis D, Roughton M, Flather MD, Coats AJS, Van Gelder IC. Effect of nebivolol on outcome in elderly patients with heart failure and atrial fibrillation: insights from SENIORS. Eur J Heart Fail. 2012;14:1171–78.

  46. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, Clausell N, Desai AS, Diaz R, Fleg JL, Gordeev I, Harty B, Heitner JF, Kenwood CT, Lewis EF, O’Meara E, Probstfield JL, Shaburishvili T, Shah SJ, Solomon SD, Sweitzer NK, Yang S, McKinlay SM. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370:1383–92.

    Article  CAS  PubMed  Google Scholar 

  47. Chen MD, Dong SS, Cai NY, Fan MD, Gu SP, Zheng JJ, et al. Efficacy and safety of mineralocorticoid receptor antagonists for patients with heart failure and diabetes mellitus: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2016;16:28.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Sarwar CM, Papadimitriou L, Pitt B, Piña I, Zannad F, Anker SD, Gheorghiade M, Butler J. Hyperkalemia in Heart Failure. J Am Coll Cardiol. 2016;68(14):1575–89.

    Article  CAS  PubMed  Google Scholar 

  49. Packer M, Holcomb R, Abraham WT, Anker S, Dickstein K, Filippatos G, Krum H, Maggioni AP, McMurray JJ, Mebazaa A, O’Connor C, Peacock F, Ponikowski P, Ruschitzka F, van Veldhuisen DJ, Holzmeister J, TRUE-AHF Investigators and Committees. Rationale for and design of the TRUE-AHF trial: the effects of ularitide on the short-term clinical course and long-term mortality of patients with acute heart failure. Eur J Heart Fail. 2016. doi:10.1002/ejhf.698 (Epub ahead of print).

  50. Ghosh RK, Banerjee K, Tummala R, Ball S, Ravakhah K, Gupta A. Serelaxin in acute heart failure: most recent update on clinical and preclinical evidence. Cardiovasc Ther. 2017;35(1):55–63.

    Article  CAS  PubMed  Google Scholar 

  51. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering treatment. 6. Prevention of heart failure and new-onset heart failure–meta-analyses of randomized trials. J Hypertens. 2016;34(3):373–84.

    Article  CAS  PubMed  Google Scholar 

  52. SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–16.

  53. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, Mattheus M, Devins T, Johansen OE, Woerle HJ, Broedl UC, Inzucchi SE, EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117–28.

    Article  CAS  PubMed  Google Scholar 

  54. Fitchett D, Zinman B, Wanner C, Lachin JM, Hantel S, Salsali A, Johansen OE, Woerle HJ, Broedl UC, Inzucchi SE, EMPA-REG OUTCOMEVR trial investigators. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOMEVR trial. Eur Heart J. 2016;37:1526–34.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Mannucci E, Monami M. Cardiovascular Safety of incretin-based therapies in type 2 diabetes: systematic review of integrated analyses and randomized controlled trials. Adv Ther. 2017;34(1):1–40.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy

    Maria Lorenza Muiesan, Anna Paini, Claudia Agabiti Rosei, Fabio Bertacchini, Deborah Stassaldi & Massimo Salvetti

  2. Department of Medicine, ASST-Spedali Civili of Brescia, Brescia, Italy

    Maria Lorenza Muiesan, Anna Paini, Claudia Agabiti Rosei, Fabio Bertacchini, Deborah Stassaldi & Massimo Salvetti

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  1. Maria Lorenza Muiesan
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Muiesan, M.L., Paini, A., Agabiti Rosei, C. et al. Current Pharmacological Therapies in Heart Failure Patients. High Blood Press Cardiovasc Prev 24, 107–114 (2017). https://doi.org/10.1007/s40292-017-0194-3

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