New Pharmacologic Agents, Guidelines Can Further Progress Heart Failure Therapies

Despite the approval of exciting new therapies for heart failure, there are still some challenges that need to be addressed to improve patient outcomes.

Sticking with the traditional guideline recommendations for patients with heart failure (HF) reduced ejection fraction (HFrEF) while implementing new therapies into practice may be the future of cardiovascular care, according to a session presented at the American College of Cardiology Scientific Sessions 2022.

Dave L. Dixon, PharmD, discussed the tremendous progress achieved in treating HF over the past few years, with various new therapies that target different aspects of the disease. Further, he explained the different treatments available and their impact on patients.

For example, although SGLT2 inhibitors were originally developed for improving glycemic control among patients with diabetes, Dixon explained how recent trials have analyzed significant SGLT2 inhibitors for patients with chronic HF. Meanwhile, soluble guanylate cyclase (sGC) is considered a “new kid on the block” that was approved by the FDA in January 2021 as an in-class agent for HF.

Vericiguat (Verquvo; Merck) is an sGC stimulatorindicated for adults with chronic HF. The medication is indicated to reduce the risk of cardiovascular death and HF hospitalization in adults with symptomatic chronic HF and ejection fraction.

Even with exciting new therapies launching, there are still some roadblocks that need to be overcome.

“We do have some new challenges around how do we implement these therapies, how do we get access for our patients?” Dixon said.

Brian Houston, MD, discussed the guideline recommendations for angiotensin receptor-neprilysin inhibitors (ARNIs), SGLT2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRA) and how they have changed much more recently.

Specifically, there is significant discussion surrounding titration guidelines, with many new proposed other sequences being released that supposedly help achieve all 4 medication classes in 4 weeks. However, Houston reiterated that guidelines are meant to serve as a standard that can be altered depending on the patient and are not meant for everyone.

“Guidelines should serve to funnel things that we disagree on and the things that we do agree on, and I think these new guidelines do,” Houston said.

Lastly, Orly Vardeny, PharmD, MS, discussed how access to novel therapies can be more complicated than one may think. It can be simple to be a part of a clinical trial or provide guideline updates; however, actions such as providing new medications to a patient, educating others on a medication, or having the confidence to counsel a patient appropriately can be difficult for care providers.

Vardeny recommends combatting these issues by implementing team-based care into practice, because there has been a massive amount of evidence supporting this system in cardiovascular disease areas.

“We know that it takes a village in HRrRF, and the latest guidelines promote the use of that village to maximize this,” Vardeny said.

Additionally, using technological approaches may be the ideal course for implementing any new novel therapies, such as virtual patient visits, electronic health record identification of eligible patients, and clinical reminders.

Regarding underrepresented groups who are not typically seen in cardiovascular clinical trials, Vardeny offered some solutions to address these challenges, such as using culturally sensitive approaches at the patient level and urging the federal level to change the paradigm for more diverse groups in trials.

Vardeny concluded that there is room for improvement in optimization of existing drug therapies for HFrEF, and that access to these novel HF therapies require new multi-modal approaches to continue to improve this area of health care.

REFERENCE

Pharmacology Session II: No Longer Failing to Treat Heart Failure — Optimizing Therapy With Newer Pharmacologic Agents. ACC 2022. April 3, 2022. Accessed April 3, 2022.