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McMaster Textbook of Internal Medicine

The 3 most important recent advances in treating heart failure

2021-07-13
Harriette Van Spall
Recorded at the 6th McMaster International Review Course in Internal Medicine (MIRCIM).

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.

See also
  • Once-weekly semaglutide in adults with overweight or obesity Dr Megha Poddar, assistant clinical professor at the Faculty of Health Sciences at McMaster University, offers a brief review of new findings on the use of semaglutide in overweight and obesity.
  • Publications of the Week, April 6 A digest of noteworthy publications curated by editors from McMaster University. This week’s focus: once-weekly semaglutide in adults with overweight or obesity.
  • (R)evolution of pharmacologic therapy for diabetes mellitus Dr Ally Prebtani, professor of medicine in the Division of Endocrinology and Metabolism at McMaster University, discusses the recently published meta-analysis of the use of SGLT-2 inhibitors and GLP-1 receptor agonists in diabetes.
  • Heart failure treatment: A decade of progress Dr Harriette Van Spall, associate professor in the Division of Cardiology at McMaster University, scientist at the Population Health Research Institute, and cardiologist at Hamilton Health Sciences, puts in context some of the most impactful heart failure clinical trials of recent years.
  • Heart failure treatment: The evolution of vasodilators Dr Harriette Van Spall, associate professor in the Division of Cardiology at McMaster University, scientist at the Population Health Research Institute, and cardiologist at Hamilton Health Sciences, discusses the evolution of vasodilators used in heart failure treatment.
  • Heart failure treatment: SGLT-2 inhibitors Dr Harriette Van Spall, associate professor in the Division of Cardiology at McMaster University, scientist at the Population Health Research Institute, and cardiologist at Hamilton Health Sciences, answers questions about the role of SGLT-2 inhibitors in heart failure treatment.
  • Hypertension in the age of COVID-19 Dr Giuseppe Mancia, professor emeritus at the University of Milano-Bicocca and past president of the International Society of Hypertension and the European Society of Hypertension, discusses the use of ACE inhibitors and ARBs in the context of COVID-19.
  • ST-segment elevation ACS ST-segment elevation acute coronary syndrome (STE-ACS/STEMI): a concise guide to diagnosis, investigations, and management.
  • Atrial fibrillation (AF) Atrial fibrillation (AF/AFib): a handy guide to assessment and management.
  • Chest pain Chest pain: an expert summary of the critical points to keep in mind during evaluation and management.
  • Non–ST-segment elevation ACS Non–ST-segment elevation acute coronary syndrome (NSTE-ACS/NSTEMI): the important points to remember regarding diagnosis, investigations, management, and risk stratification.
  • Adjusting exercise in patients with heart failure How to adjust the level of exercise in a patient with heart failure?

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