AHA 2020 came and went, and now is the time to put into context the scientific advances presented. While all areas of cardiology saw therapeutic innovations, the ever-evolving landscape for heart failure (HF) therapies stood out in particular.
These were among the key discoveries shared at AHA20 in the HF space:
GALACTIC-HF: In patients with chronic heart failure with a reduced ejection fraction (HFrEF), the cardiac-specific myosin activator omecamtiv mecarbil reduced the primary composite endpoint of time to HF event or cardiovascular death, driven by a reduction in hospitalizations and ED visits. Importantly, the therapy appeared to be hemodynamically neutral, and subgroup analysis showed those with lowest ejection fraction (EF) may benefit in particular.
AFFIRM-AHF: In patients with HFrEF and iron deficiency stabilized from an acute HF event, IV iron repletion reduced the risk of subsequent hospitalization for HF but not death.
SOLOIST-WHF: In patients with worsening HF, the SGLT1/2 inhibitor sotagliflozin significantly reduced the risk of death and hospitalization for HF subgroup analysis showed the results persisted regardless of EF.
SCORED: In patients with diabetes and chronic kidney disease, sotagliflozin reduced the risk of cardiovascular death and subsequent hospitalization and/or urgent visits for HF. Similarly, the effect was seen regardless of EF.
These results not only add to the proven therapies for HFrEF including the cornerstones of ARNI, MRA, BB, and SGLT2 inhibitors, they add therapies for worsening heart failure and strongly suggest therapy for heart failure with a preserved ejection fraction. They may even hint at therapy for those with very low EF. With the VICTORIA trial showing benefit for vericiguat at ACC 2020, and additional therapies already indicated for subsets of patients including ivabradine and fixed-dose isosorbide dinitrate and hydralazine, we now find ourselves with a number of medications our patients should be receiving.
The path forward will be deciphering how best to implement these therapies at doses with proven benefit. Dealing with the issue of cost will be key. Sequencing trials, collating datasets with prescription fill data, machine learning tools to support clinical decision making, and personalized medicine through “omics” technologies may all play a role, as recently discussed by the HF Collaboratory (1).
While there is much to be seen, it’s certainly a very exciting time for heart failure!
- Bhatt AS, Abraham WT, Lindenfeld J et al. Treatment of HF in an Era of Multiple Therapies: Statement From the HF Collaboratory. JACC: Heart Failure 2020.
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