Comprehensive Therapy Lowers Risk for Cardiovascular Death or Heart Failure Hospitalization by Over 60%
Written by John Steuter, MD, FACC
Heart failure has long since plagued the human race. Over the years countless pharmacological therapies have been developed to help treat and increase the quality of life for patients suffering from heart failure. As more pharmacological therapies become available, the need to evaluate the effectiveness from one treatment versus another is necessary for the advancement of heart failure care.
In the last 10 years, three new agents have shown a survival benefit in this population:
- Mineralocorticoid receptor antagonist (MRA)
- Angiotensin receptor-neprilysin inhibitor (ARNI)
- Sodium glucose cotransporter-2 (SGLT-2) inhibitor
However, these new agents’ benefits have not been compared to the results found in conventional therapy treatments.
Cross-Trial Shows Comprehensive Therapy Lowers Risk
Recently data became available from a cross-trial study indicating that comprehensive therapy lowers risk for cardiovascular death or heart failure hospitalization by over 60%. This cross-trial study reviewed data from:
- EMPHASIS-HF
- PARADIGM-HF
- DAPA-HF
For the purpose of this study, “comprehensive therapy” was defined as a combination of MRA, beta-blocker, ARNI and SGLT-2 inhibitor. The pharmacological effect of comprehensive therapy was tested against conventional therapy (angiotensin-converting enzyme [ACE] inhibitor or angiotensin-receptor blocker [ARB] and beta-blocker). The main result after comparison of the data from these three trials were either cardiovascular death or first heart failure-related hospitalization.
Results from analysis of the three trials:
- When compared to ACE inhibitor/ARB therapy with a beta-blocker, comprehensive therapy with ARNI, beta-blocker, MRA and SGLT-2 inhibitor was associated with a 60% lower hazard for cardiovascular death and HF hospitalization
- Number needed to treat to prevent one cardiovascular death or heart failure hospitalization with comprehensive therapy was six; down from eight compared to ACE inhibitor/ARB and beta-blocker
- Number needed to treat to prevent one all-cause mortality comprehensive therapy was eight; down from 16 compared to ACE inhibitor/ARB and beta-blocker
- Baseline life expectancies varied by age and survival gains were calculated across ages 55-80 years.
- At age 55 – 65 years, survival was 6.3 years more with comprehensive therapy compared to conventional therapy
- At age 80 years, survival with comprehensive therapy was 2.7 years more
While the data from this study is promising, additional components such as ARNI and SGLT-2 inhibitors not being available in generic form (therefore increasing the financial cost for patients), plus the fact that HFrEF therapy will now include at least four different medications, medication compliance from the patient is also a factor in the successfulness of a comprehensive pharmacological therapies for heart failure patients.
Bryan Heart Improvement Program Provides Leading Edge Heart Failure Care
Despite these hurdles, Bryan Heart is here to help serve you and your heart failure patients. Our Bryan Heart Improvement Program (BHIP) team specializes in heart failure care and we will work with you and your patient to discuss treatment options that best fit their individual needs.
For additional information or to refer a patient to our BHIP or heart failure team, please call 402-483-3333.
References:
Supria Shore, MD Lifetime Benefits of Pharmacological Therapy in HFrEF; June 5, 2020 https://www.acc.org/latest-in-cardiology/journal-scans/2020/06/05/10/59/estimating-lifetime-benefits-of-comprehensive
Muthiah Vaduganathan, MD, Brian L Claggett, PhD, Pardeep S Jhund, PhD, Jonathan W Cunningham, MD, João Pedro Ferreira, MD, Prof Faiez Zannad, MD, et al. Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials; May 21, 2020 https://doi.org/10.1016/S0140-6736(20)30748-0
