Guidelines Aid in Management of Heart Failure, Associated Complications

Guideline-based management approaches can improve quality of care and outcomes for patients with heart failure and arrhythmic complications, according to a presentation given at the ASHP 2017 Midyear Clinical Meeting and Exposition.

Although heart failure management has improved over time, the disease is still associated with high morbidity and mortality rates, with projected increases of approximately 50% by 2030. Costs of heart failure management are projected to increase alongside the forecasted rise in diagnoses.

The introduction of treatment guidelines have addressed the use of biomarkers as diagnostic and prognostic tools, as well as newly available therapies and the management of heart failure with reduced ejection fraction (HFrEF), anemia, and hypertension.

James Tisdale, PharmD, BCPS, FAHA, FAPhA, FNAP, professor at Purdue University, and Jo E Rogers, PharmD, BCPS, FCCP, FNAP, FHFSA, FAHA, clinical associate professor at UNC Eshelman School of Pharmacy, outlined how guidelines are now used in cardiac care management of heart failure.

As new therapies emerge for HFrEF, guideline updates have highlighted managing the underlying diseases associated with heart failure, including hypertension and atrial fibrillation (AF). First-line therapy indications include use of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker plus beta-blocker. Newly indicated therapies include the combined neprilysin/angiotensin receptor blocker sacubitril/valsartan in patients with chronic HFrEF, as well as ivabradine in patients with normal sinus rhythm and a heart rate greater than 70 beats per minute.

Guidelines for the management of hypertension, based on findings from the SPRINT trial, suggested a goal systolic blood pressure below 130 mm Hg. Anemia management in patients with heart failure and iron deficiency recommended the use of intravenous iron to increase functional status and improve quality of life.

Patients with heart failure and AF face an increased risk for stroke and systemic embolism. Guidelines recommend similar management among patients with AF with or without heart failure if they have normal left ventricular function, centering around oral anticoagulation. However, heart failure patients with compromised renal functioning should receive appropriate adjustments to their nonvitamin K oral anticoagulants.

Ventricular arrhythmias—which can cause sudden cardiac death—are commonly seen in heart failure patients. Stable hospitalized patients can receive intravenous amiodarone, as well as procainamide and sotalol. “Patients with heart failure and a history of life-threatening arrhythmias or some with nonsustained venous thromboembolism or unexplained syncope require implantation of an implantable cardioverter-defibrilator,” Drs Tisdale and Rogers wrote.

—Cameron Kelsall