Two new drugs were recently approved by the Food and Drug Administration for use in treating heart failure. Researchers have been studying the effect these new drugs have on patients for whom they have been prescribed. As a result of the positive results patients experienced, the American College of Cardiology, the American Heart Association and the Heart Failure Society of America have updated their 2013 Guideline for the Management of Heart Failure (Guideline update published). The update incorporates these new drugs into the drug treatment guidelines for heart failure, which will be used by physicians, and patients seeking information about their treatment options.
Healthcare providers reading the guideline update will learn how and for whom these drugs can be used. This patient friendly version translates the scientific update into more understandable information to advise patients, their families and caregivers of the availability of the new drugs, and when and how they should be taken.
To decrease illness and death and to improve the function of the heart in chronic heart failure patients with reduced heart function, a variety of drugs are prescribed. These drugs are known as ACE inhibitors, angiotensin-receptor blockers (ARBs), aldosterone antagonists, beta blockers, diuretics and the combination of a nitrate with hydralazine.
The updated guidelines give the strongest recommendation regarding the benefits of treatment for use of an ACE inhibitor or an ARB, and announce the alternative of an angiotensin receptor-neprilysin inhibitor (ARNI) as a prescription treatment option. The ARNI is the new drug sacubitril/valsartan (Entresto). ACE inhibitors, ARBs, or an ARNI are recommended to be used in conjunction with beta blockers and aldosterone antagonists in selected patients with chronic heart failure with reduced heart function.
In selected patients with symptoms of chronic heart failure with reduced heart function, the update gives, as an option, replacing an ACE inhibitor or ARB with an ARNI. The ARNI has been added due to the results from a study which reported a significant reduction in cardiovascular death or hospitalization for heart failure. Patients who switch to an ARNI will need clinical management to determine the optimal dose and tolerance of this new drug. An ARNI should NOT be administered with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor, nor should it be taken by patients with a history of angioedema, which is swelling under the skin.
For those patients in whom an ARNI is not appropriate, the guideline strongly advises the continued use of an ACE inhibitor for all classes of heart failure with reduced ejection fraction. The guideline recommends the use of ARBs for those patients in whom an ACE inhibitor or ARNI are inappropriate.
Ivabradine (Corlanor) is the second drug added to as a treatment option for chronic heart failure or stable chronic heart failure to reduce hospitalization for heart failure. The guideline notes that this drug can be beneficial for patients in normal heart rhythm with a resting heart rate of 70 or greater, who are already receiving a beta blocker at a maximum tolerated dose. The guideline noted that patients who had a heart attack within two months were excluded from the study, therefore there are no data on the effectiveness of Ivabradine for those patients.
Finding the best treatment for each heart failure patient should be the goal for all providers and the expectation for patients and their families. If you have questions about treatment options or would like more information regarding your care, talk to your doctor. The benefits and risks of your treatments should be carefully explained and well understood to facilitate shared decision making and ensure confidence in your plan of action.