ACP: Clyde Yancy, MD, MSc Reviews Advances in Heart Failure Research and Treatment
ACP: Clyde W Yancy, MD, gave a comprehensive update on a year's worth of pivotal science in treatment of heart failure. Here are the highlights.
A presentation by Clyde Yancy, MD, MSc, is nearly always memorable – his eloquence, passion, and turn of phrase are worth an hour in a frigid hotel ballroom any time.
While his session today at the American College of Physicians Internal Medicine Meeting 2021: Virtual Experience was via Zoom, his review of the past 12-15 months of research in cardiology, and specifically in heart failure, was no less animated and his messages were clear:
- Use the new HF diagnostic and risk scoring tools to identify at-risk patients and take action.
- Optimize guideline recommended medical therapy for patients with heart failure.
- Pay attention to evolving treatment options for HFpEF.
- Be sure to review and understand the evidence that now substantiates the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) fore treatment of heart failure and comorbidities.
The slide show that follows is based on Dr Yancy's presentation and includes links to all of the primary studies that he discusses.
A New Universal Definition of Heart Failure
A revised look at midrange between HFrEF and HFpEF and at those with improved EF in response to guideline directed medical therapy.
New scoring systems to estimate risk of heart failure. “10-Year Risk Equations for Incident Heart Failure in the General Population”
Another new scoring system to estimate risk for heart failure. The H2FPEF score. A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction. Circulation.
Guideline-directed medical therapy for HF is suboptimal. Prescribing implementation barriers are to blame; there are potential methods being investigated to improve effective prescribing.
Changing the treatment paradigm in HF – are SGLT2is the answer?
DAPA-HF trial: Effect of dapagliflozin in HF, with/without T2D. An inflection point in the care of patients with HF.
EMPORER-Reduced trial: Cardiovascular and renal outcomes with empagliflozin in heart failure.
DAPA-CKD trial: Dapagliflozin in patients with chronic kidney disease.
SGLT2is and HFpEF? EMPORER-Preserved rationale for and design of study.
The most recent data: Sotagliflozin. SOLOIST WHF trial: Sotagliflozin in patients with diabetes and recent worsening heart failure
Sotagliflozin. SCORED trial: Sotagliflozin in patients with diabetes and chronic kidney disease.
SGLT2i in HF: Soon to be guideline directed first-line therapy? 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment. Interim guidance statement adds angiotensin receptor-neprilysin inhibitors (ARNIs) and SGLT2is to treatment algorithms for new-onset and chronic heart failure in this update on the treatment of HFrEF.
Summary of progress in treatment for HF.
Table ©2021 American College of Physicians. All rights reserved.
Reminder that appropriate use of guideline-directed, evidence-based medical therapies leads to risk reduction for patients.
Note: Updated from Fonarow GC, et al. Am Heart J 2011;161:1024-1030 and Lancet 2008;372:1195-1196.
Dr Yancy's teaching points:
• Review the new universal definition of heart failure
•Identify best uses of new prevention and diagnostic risk •scores
•Appreciate the benefit of optimal guideline directed medical •(& device) therapy for heart failure
•Be aware of evolving treatment options for HFpEF
•Review the evidence substantiating the use of SGLT2 inhibitors for the prevention and treatment of heart failure
Clyde W. Yancy, MD, MSc, is Vice Dean of Diversity and Inclusion, Chief of Cardiology, Magerstadt Endowed Professor of Medicine Chair, and Professor of Medical Social Sciences at Northwestern University Feinberg School of Medicine; Associate Director of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital, Chicago, IL.
