Nav: Home

Multi-drug regimen for heart failure could meaningfully extend patients' lives

May 21, 2020

Patients with heart failure have substantially shorter life expectancies than people without this condition. Approximately 6.5 million people in the U.S. and over 64 million people worldwide have heart failure, and about half of them have heart failure with reduced ejection fraction (HFrEF). In the last three decades, there have been many advancements in the treatment of HFrEF with several new drugs showing promising results in randomized, controlled clinical trials. However, uptake of new therapies has been slow. A team led by investigators from Brigham and Women's Hospital has conducted an analysis to estimate the potential benefits of using a comprehensive regimen that incorporates newer therapies into clinical practice compared to using a more conventional regimen. The team found that comprehensive therapy could extend lifespan up to six years and eight years free from cardiovascular death or first hospital admission for HFrEF. Results are published in The Lancet.

"There's been some resistance to adopting comprehensive therapy for heart failure patients," said corresponding author Scott Solomon, MD, of the Brigham's Cardiovascular Division. "What we did here was to say, 'What might the benefit be over a patient's lifetime?' And the benefit we're seeing is pretty dramatic."

"Across a broad range of ages, these therapies, when implemented in combination, may meaningfully improve life expectancy and help patients remain out of the hospital," said lead author Muthiah Vaduganathan, MD, MPH, also of the Brigham's Cardiovascular Division.

To conduct their analysis, Solomon, Vaduganathan and colleagues leveraged data from three previously conducted randomized, clinical trials. Each trial evaluated a therapy for heart failure patients: mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNI), and sodium/glucose cotransporter (SGLT2) inhibitors. Drawing on the data from these trials, the team conducted an actuarial analysis to estimate the lifetime benefit of taking all three drugs in addition to a conventional regimen.

Their analysis found that over the course of a lifetime of use, assuming consistent treatment benefits, the comprehensive regimen could add up to eight years of survival free from cardiovascular events and hospitalization due to heart failure. While younger patients with HFrEF would stand to benefit the most, the researchers reported gains in life expectancy for all age groups analyzed.

Offering readily understandable metrics for clinicians and patients to be able to refer to when discussing treatment options was important to the authors, especially amid the COVID-19 pandemic.

"Patients with heart failure are especially vulnerable during COVID-19 and ensuring effective preventive care for this high-risk segment of the population is a top priority in the next phase of the pandemic planning," said Vaduganathan.

The authors note that their analysis has certain limitations, including assumptions about the therapy, adherence, and that benefits would continue to accrue over time. In addition, the analysis does not examine the costs of heart failure drugs or the potential side effects -- such as kidney toxicity -- of taking these drugs in combination.
-end-
Vaduganathan has served on advisory boards for Amgen, AstraZeneca, Baxter Healthcare, Bayer, Boehringer Ingelheim, Cytokinetics, and Relypsa. Solomon has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, BMS, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lone Star Heart, Mesoblast, MyoKardia, NIH/NHLBI, Neurotronik, Novartis, Respicardia, Sanofi Pasteur, Theracos, and has consulted for Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, BMS, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, Gilead, GSK, Ironwood, Merck, Myokardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, Tenaya, Sanofi-Pasteur, Dinaqor, and Tremeau.

Paper cited: Vaduganathan M 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" The Lancet DOI: 10.1016/S0140-6736(20)30748-0

Brigham and Women's Hospital

Related Heart Failure Articles:

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.
Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population
Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.
Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.
Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.
Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.
How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.
Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.
NSAID impairs immune response in heart failure, worsens heart and kidney damage
Non-steroidal anti-inflammatory drugs, or NSAIDs, are widely known as pain-killers and can relieve pain and inflammation.
Heart cell defect identified as possible cause of heart failure in pregnancy
A new Tel Aviv University study reveals that one of the possible primary causes of heart failure in pregnant women is a functional heart cell defect.
More Heart Failure News and Heart Failure Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Clint Smith
The killing of George Floyd by a police officer has sparked massive protests nationwide. This hour, writer and scholar Clint Smith reflects on this moment, through conversation, letters, and poetry.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Nina
Producer Tracie Hunte stumbled into a duet between Nina Simone and the sounds of protest outside her apartment. Then she discovered a performance by Nina on April 7, 1968 - three days after the assassination of Dr. Martin Luther King Jr. Tracie talks about what Nina's music, born during another time when our country was facing questions that seemed to have no answer, meant then and why it still resonates today.  Listen to Nina's brother, Samuel Waymon, talk about that April 7th concert here.