Sequencing of treatments for heart failure with reduced ejection fraction (HFrEF)
Sequencing of treatments for heart failure with reduced ejection fraction (HFrEF)
With the arrival of new effective therapies for the treatment of heart failure with reduced ejection fraction (HFrEF), one of the hottest topics concerns the best sequencing of therapies. During the 2023 edition of the Heart Failure Association Congress - we spoke about this with Scott Solomon from Brigham and Women’s Hospital in Boston.
Segui Cardioinfo:
Website: https://bit.ly/3fzgryk
Twitter: https://bit.ly/2AGPpqj
Linkedin: https://bit.ly/2UVRCET
Content
0.77 -> [Music]
1.62 -> foreign
3.09 -> [Music]
14.96 -> I think what we have to remember is that
17.94 -> we we want to treat our patients with
22.76 -> the guideline directed for pillars of
25.5 -> therapy so these include either ACE
28.68 -> inhibitors arbs or succubital Valsartan
31.019 -> and I would argue succubutro Valsartan
33.059 -> is clearly Superior to ACE inhibitors or
37.2 -> arbs
38.899 -> sglt2 Inhibitors beta blockers and
41.66 -> mineralocorticoid receptor are
43.2 -> antagonists and the question is how do
45.6 -> we get our patients on all of those
47.399 -> drugs is there a sequence we should
50.219 -> follow
51.92 -> to be honest there's no clinical trial
55.559 -> that's ever been done that has actually
58.559 -> tested which of these
60.96 -> to use first so we have to use some
64.559 -> judgment and I would argue that
68.36 -> there are a couple of real
70.88 -> potential answers here first of all ease
75 -> of use sglt2 Inhibitors are very easy to
79.2 -> use
80.18 -> one dose essentially no titration very
84.72 -> few side effects and that's why many of
87.479 -> us are getting very aggressive about
89.28 -> using this class of drugs and they're
91.2 -> useful across the full spectrum of
93.36 -> ejection fraction socubatro Valsartan
96.259 -> should be used instead I believe
100.04 -> instead of an Ace inhibitor or ARB even
102.9 -> in patients with the novo heart failure
105.6 -> even in patients who've never been on an
108.72 -> Ace inhibitor or ARB before because the
112.02 -> Paradigm trial showed dramatic benefit
114.84 -> very very early on with reduction in
118.02 -> morbidity and most importantly mortality
121.399 -> SO waiting will put your patients at
125.159 -> risk now of course we want to get our
128.22 -> patients also on mineralocorticode
130.08 -> receptor antagonists and our own data
132.66 -> from the Paradigm trial suggests that if
135.18 -> you have a patient on a circumatural
138.18 -> Valsartan their risk of developing
140.7 -> severe hyperkalemia with a
143.78 -> mineralocorticoid receptor antagonist is
146.58 -> far less than it would be if these
149.52 -> patients were on an Ace inhibitor so I
153.06 -> would argue that we should have our
154.62 -> patients on succubital Valsartan prior
157.02 -> to putting them on a mineralocorticoid
160.86 -> receptor antagonist and then finally all
164.04 -> of our patients should be on beta
165.9 -> blockers they reduce mortality they
167.76 -> improve cardiac remodeling but in terms
172.92 -> of sequence maybe we should think about
175.8 -> starting
178.04 -> sglt2 Inhibitors and mras first you
181.319 -> could start an sglt2 inhibitor probably
186.26 -> and we have to of course
189.08 -> make sure at the end of the day our
192.12 -> patients are on some dose
194.879 -> of all four pillars of uh of guideline
199.319 -> directed medical therapy we've shown
202.26 -> that if you get patients on all four of
205.379 -> these compared to people who are just on
208.019 -> ACE inhibitors arbs and beta blockers
211.159 -> you can reduce
214.4 -> cardiovascular death and heart failure
216.36 -> hospitalization by about 60 percent and
219.06 -> you can extend Life by up to eight years
222.62 -> very important to our patients
Source: https://www.youtube.com/watch?v=cVk2NbYkDek