Pharmacotherapy Session – Advances in heart failure pharmacotherapy

Linked to EAHP Statements
Section 4 – Clinical Pharmacy Services – Statement 1 

ACPE UAN: 0475-0000-22-018-L01-P. A knowledge based activity.

Abstract

Heart failure (HF) is a complex clinical syndrome where the efficiency of the heart is impaired and it is unable to meet the demands of the body. HF is a major healthcare concern as it is associated with high mortality, morbidity, and substantial economic burden to the health systems.

In patients with HF, the treatment goals are to reduce mortality, improve clinical status and quality of life (QoL), and prevent hospital admissions. HF treatments depend on the type of HF the patient has, which, as defined by the 2021 European Society of Cardiology (ESC) guidelines, can be: HF with reduced ejection fraction (HFrEF) if EF<40%, mildly reduced (HFmrEF) if EF 41-49% and preserved (HFpEF) if EF >50%.

Pharmacotherapy for HF management continues to advance due to the development in recent years of new drugs such as sacubitril-valsartan, dapagliflozin and empagliflozin. Sacubitril-valsartan is the first-in-class angiotensin receptor neprilysin inhibitor which has demonstrated a significant mortality benefit in HFrEF patients. Dapagliflozin or emplagliflozin are sodium-glucose cotransporter 2 inhibitors (SGLT2s) originally developed as antihyperglycemic agents, but which have proved to have beneficial effects in HF.

ARNI or Angiotensin-Converting enzyme Inhibitors (ACEi) (or angiotensin-receptor blockers (ARB) in ACEi-intolerant patients), β- blockers (BB), mineralocorticoid receptor antagonists (MRAs) and SGLT2s combine to form the Guideline-Directed Medical Therapy (GDMT) for HF. GDMT has proven to help in reducing hospitalization and mortality of HFrEF patients and the same treatment can be considered in patients with HFmrEF.  No therapy has convincingly shown to give a mortality benefit in patients with HFpEF.

This seminar will focus on the pharmacological options currently available for the treatment of HF.

Learning objectives

After the session, participants should be able to:

• Recognise pharmacological treatments for HF;
• Explain the mechanism of action of new medications used in HF;
• Discuss the importance of optimal use of GDMT for HF.

Educational need addressed
This seminar addresses the advances in pharmacotherapy made in recent years to reduce mortality, improve clinical status and QoL, and prevent hospital admissions of patients with HF.  

Keywords: Heart Failure, Medication Therapy Management, Cardiovascular disease