Heart Failure Happy Hour
Volume 8, Issue 3
Heart failure (HF) remains a leading cause of mortality in the United States and around the world. In the last several years, the field of heart failure pharmacotherapy has moved rapidly from relative stagnation to one with several new drugs publishing very favorable data.
In this week’s episode of Talking Therapeutics, we discuss two new studies that shed more light on two new classes of HF drug therapies.
Point 1: SGLT2 Inhibitors Continue to Impress for HFpEF
HFpEF has historically be recalcitrant to traditional HF drug therapies like ACE inhibitors and beta-blockers. Earlier this year the SGLT2 inhibitor empagliflozin became the first medication to demonstrate improved rates of HF-related hospitalization and cardiovascular death in a diverse cohort of HFpEF patients. This week, additional data was published on the benefits of empagliflozin on worsening HF events. This trial showed in addition to reducing hospitalizations for heart failure or need for an emergency or urgent heart failure visit requiring intravenous treatment, empagliflozin reduced the total number of heart failure hospitalizations that required intensive care (HR 0.71 [95% CI, 0.52–0.96]; P=0.028) and the total number of all hospitalizations that required a vasopressor or positive inotropic drug (HR, 0.73 [95% CI, 0.55–0.97]; P=0.033). Most impressively, these benefit reached statistical significance at 18 days after randomization.
Additionally, this trial found that compared with patients in the placebo group, fewer patients in the empagliflozin group reported outpatient intensification of diuretics and patients assigned to empagliflozin were 20% to 50% more likely to have a better New York Heart Association functional class.
Point 2: Omecamtiv Seems to Benefit the Sickest of the Sick
Limited treatment options exist for those with advanced or severe HF. This week, additional data from the GALACTIC-HF study was published exploring the use of omecamtiv in patients with severe HF, which was defined as the presence of all of the following criteria: New York Heart Association symptom class III to IV, left ventricular ejection fraction of 30% or less, and hospitalization for HF within the previous 6 months. Patients with severe HF who received omecamtiv had a significant reduction in the time to HF event or cardiovascular death (hazard ratio [HR], 0.80; 95% CI, 0.71-0.90), whereas patients without severe HF had no significant treatment benefit (HR, 0.99; 95% CI, 0.91-1.08; P = .005 for interaction). Omecamtiv therapy was well tolerated in patients with severe HF, with no significant changes in blood pressure, kidney function, or potassium level compared with placebo.
This trial is exciting as patients with severe HF often cannot tolerate traditional HF therapies and as such experience a significantly high number of adverse HF-related events. Omecamtiv may represent a unique therapy option specifically for patients with severe HF.
Disclaimer: The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policy or position of the Population Health Learning Network or HMP Global, their employees, and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, or anyone or anything.
