Best of heart failure

67 3. Solomon SD, Dobson J, Pocock S, S Granger CB, Yusuf S, Swedberg K, Y Pfeffer MA, for the Candesartan in Hea Reduction in Mortality and morbidity (2007) Influence of nonfatal hospitaliz subsequent mortality in patients wit Circulation 116(13):1482 – 1487 4. Ramirez A, Abelmann WH (1974) C NEJM 290(9):499 – 501 5. Peacock WF, Braunwald E, Abraham Christenson R, Collins S, Diercks D, Kellerman A, Gheorghiade M, Kirk D, BM, O'Connor C, Pang P, Shah M, Sopk A, Teerlink J (2010) National Heart, L working group on emergency departme heart failure: research challenges and op 343 – 351 6. Hamo CE, Butler J, Gheorghiade M, bumpy road to drug development for Heart J Supp 18(Supplement G):G19 – G 7. Gheorghiade M, Braunwald E (2011) A assessment and management of acute JAMA 305:1702 – 1703 8. Ponikowski P, Voors AA, Anker SD et al the diagnosis and treatment of acute and task force for the diagnosis and treatment failure of the European Society of Car with the special contribution of the Hea the ESC. Eur Heart J 37(27):2129 – 2200 9. Cleland JG, Pennel D, Ray S, Murray G, Coats A, Lahiri A (1999) The Carvedil Ischemia Trial: Marker of Success (CHRI 1:191 – 196 10. Cleland JG, Pennell DJ, Ray SG, Co Murray GD, Mule JD, Vered Z, Lahiri reversible ischaemia trial: marker of suc half of the CHRISTMAS (Carvedilol Ischaemia Trial: Maker of Success Myocardial viability as a determinant o sponse to carvedilol in patients with he trial): randomised controlled trial. Lancet 11. Greene SJ, Vaduganathan M, Gheorghia road to recovery: therapeutic and clinical functional viable myocardium in heart fai fraction. Eur J Heart Fail 19(7):870 – 872 12. Adamsom PB, Magalski A, Braunschwei right ventricular hemodynamics in heart measurements derived form an implanta Am Coll Cardiol 41:565 – 571 13. Zile MR, Bennett TD, St John Sutton from chronic compensated to acute dec pathophysiological insights obtained fro of intracardiac pressures. Circulation 118 14. Stevenson LW, Perloff JK (1989) The lim signs for estimating hemodynamics in ch 261:884 – 888 15. Gheorghiade M, Follath F, Ponikowski Cleland JG, Dickstein K, Drazner MH, Jondeau G, Sendon JL, Mebazaa A, Met PS, Seferovic P, Stevenson LW, van Anker SD, Rhodes A, McMurray J, Society of Cardiology, European So Medicine (2010) Assessing and grading failure. Eur J Heart Fail 12(5):423 – 433 16. Ambrosy AP, Khan H, Udelson JE, Ment SJ, Vaduganathan M, Subacuis HP, Ko Heart Fail Rev (2018) 23:597 – 607 recommended to be in reach the target 97/10 should not be given c to risk for angioedema, stopped for 36 h bef patients with eGFR < impairment, the starti daily and ARNI is not hepatic impairment [ 3 With the results of t ommendations have b HF Guidelines. First, ACE inhibitors or an strategy of RAS inhibit or ARB or ARNI. T strategy of i hibition of evidence: A), or A (level of evidence: B – beta-blockers and aldo is ecommended for p morbidity and mortalit In the 2017 Focuse with chronic symptom tole ate an ACE inhibit recommended to furth 36 •• ]. In those patie switched to ARNI fro to note that ARNI sho with ACE inhibitors or inhibitor due to angio should not be administ edem [ 1 •• ]. In the stu inhibition, blacks and angioedema [ 35 ]. It is be educated about rec ma and to lert health scription of ACE inhi In a phase II trial i served ejection fractio reater extent than di tolerat d [ 39 ]. The eff compensated HF, in a IV symptoms, or in p time and is bei g te te Ivabradine Ivabradine is a specifi chann l. If io ch n el in spontaneously activ node, the AV node, an is a mixed Na/K curre at voltages in the dia 39 Page 4 of 9 being available in the 1960s and torsemide in 1990s) [ 45 ]. Although definitive clinical outcome data are lacking, com- pelling data support torsemide as having distinct advantages over other available loop diuretics [ 46 , 47 ]. Torsemide has a significantly better bioavailability independent of the presence of gut edema or renal dysfunction [ 48 , 49 ]. Compared to fu- rosemide ’ s variable bioavailability from 10 to 90% depending on disease state, torsemide ’ s bioavailability is reliably > 80% independent of medical status [ 50 ]. An added benefit of tor- semide is its longer duration of action (12 – 18 h) compared to furosemide and bumetanide (6 to 8 h) and its decreased ten- dency for hypokalemia. The TRANSFORM-HF (Torsemide Comparison with Furosemide for Management of HF) trial is a large-scale randomized controlled trial currently enrolling approximately 6000 patients hospitalized for HF and will compare the effects of torsemide and furosemide on long- term clinical outcomes (NCT03296813). Thiazide diuretics Patients who require chronic diuretic use can frequently develop loop diuretic tolerance due to distal nephron segment hypertrophy and enhanced sodium reabsorp- tion proximal to the diuretic ’ s site of action [ 51 ]. Thiazide diuretics can play an important part in potentiating the sodium excretion effects of loop diuretics in these patients [ 32 ]. By targeting the distal tubules, thiazides provide a synergistic ef- fect when combined with standard loop diuretics and prevent reabsorption of sodium and water in the ascending loop of Henle and distal convoluted tubules [ 52 ]. A current ongoing CLOROTIC (Combination of Loop with Thiazide-type Diuretics in Patients with Decompensated Heart Failure) trial aims to determine utility of combined loop and thiazide diuret- ic compared to loop diuretic use alone (NCT01647932). Ivabradine is a chronotropic agent that decreased heart rate and, therefore, cardiac work. It has shown to be beneficial in a specific cohort of chronic HF patients with EF < 35% and heart rate > 70 BPM where it decreased the rate of HF hospitaliza- tions and death from HF 32 . Initiation in the post-discharge phase should be considered among HFrEF patients already receiving optimal doses of standard GDMT [ 53 ]. However, in the stable HF patient admitted for acute decompensation, consideration should be made to initiate prior to discharge. The PRIME-HF (Predischarge Initiation of Ivabradine in the Management of Heart Failure) trial is a r ndomized prospec- tive study that aims to monitor the rate of continued tre tment of ivabradine if started in the predischarge period rather than i clinic (NCT02827500). This information can help guide rec- ommendations for timeline of initiation of therapy. Angiotensin receptor and neprilysin inhibitors (ARNI) have been shown to improve vasodilation and natriuresis by inhibiting endothelin, vasopressin, sympathetic activity, and the RAAS [ 54 ]. The PARADIGM-HF (Prospectiv Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial demon- strated better outcomes in HFrEF with treatment with ARNI compared to ACEI [ 55 , 56 ]. Post hoc analysis of the PARADIGM-HF suggests that these ben fits extend t im- proving clinical outcomes following hospitalization for HF and initiation should be considered during outpatient clinic visits [ 57 ]. The ongoing PIONEER-HF (comparison of sacubitril/valsartan versus enalapril on effec on NT-pr BNP in patients stabilized from an acute heart failure episode) trial is a large, randomized, double-blind prospective study that aims to assess the effect on congestion by monitoring NT- proBNP levels in the post-discharge setting (NCT02554890). Table 1 Summary of underutilized heart failure therapies Therapy Recommendation Supporting trials Digoxin Use in refractory HFrEF in addition to GDMT to decrease rate of rehospitalization DIG Trial (1997) MRAs HFrEF patients with NYHA III – IV symptoms RALES (1999) HFpEF patients with normal renal function TOPCAT (2014) Torsemide Consideration of torsemide over furosemide as oral loop diuretic therapy in patients with difficult to treat congestion or diuretic resistance TRANSFORM-HF (current) Thiazides Use in combination with loop diuretics in diuretic resistant patients CLOROTIC (current) Ivabradine HFrEF patients on maximal GDMT with standing HR > 70 BPM SHIFT (2010) ARNIs HFrEF patients in place of ACEI PARADIGM-HF (2014) PIONEER-HF (current) Ultrafiltration In ADHF with congestion refractory to medical therapy (level of evidence: C) RAPID-CHF (2005) CARRESS-HF (2012) HFrEF heart failure with reduced ejection fraction, GDMT guideline-directed medical therapy, NYHA New York Heart Association, HFpEF heart failure with preserved ejection fraction, HF heart failure, HR heart rate, BPM beats per minute, ARNI angiotensin receptor – neprilysin inhibitors, ACEI ACE inhibitor, ADHF acute decompen- sated heart failure 602 Heart Fail Rev (2018) 23:597 – 607