Dr Harriette Van Spall is an associate professor in the Division of Cardiology at McMaster University, scientist at the Population Health Research Institute, and cardiologist at Hamilton Health Sciences.
If you were to name the 3 most important recent advances relevant for everyday practice in heart failure, what would they be?
Harriette Van Spall, MD, MPH: What’s new in the management of heart failure with reduced ejection fraction (EF)? The first thing is primary prevention: Recognize the risk factors for heart failure—including coronary artery disease, myocardial infarction, obesity, atrial fibrillation, hypertension, diabetes, and sex-specific risk factors, including early menopause, pregnancy disorders such hypertensive disorders of pregnancy, gestational diabetes, polycystic ovarian syndrome—and treat them to prevent the incidence of heart failure.
A second new aspect is quadruple therapy that comprises angiotensin receptor neprilysin inhibitors (ARNIs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 (SGLT-2) inhibitors, keeping in mind that the strategies for initiating and optimizing these therapies have also changed. Instead of the sequential initiation and uptitration of these drugs, we are now promoting simultaneous initiation of all 4 classes as soon as possible and then uptitrating the doses so that patients are on target doses as soon as possible, without any delay in therapies.
Another new aspect of heart failure care is the use of health-care technology such as virtual clinics, remote monitoring, telemonitoring, the use of artificial intelligence and machine learning to anticipate, predict outcomes among patients with heart failure.
And then, of course, the continued therapies for heart failure after patients are in remission and recover their EF. We now know that cessation of these therapies precipitates heart failure.
So, that’s what’s new and hot in heart failure. Keep it in mind to optimize care for your patients.