Verquvo Is A Promising New Heart Failure Treatment
The drug is indicated to reduce the risk of cardiovascular death, HF hospitalizations, or the need for outpatient intravenous diuretics.
Heart failure is a chronic condition in which the heart cannot pump adequate blood to the body.
This results in the heart not being able to pump enough blood and fill appropriately. A condition such as this can create many problems for patients who suffer from HF, such as continuous shortness of breath, fatigue, rapid heartbeat, and swollen legs.
Treatment options for HF include dietary measures, as well as medications according to national guidelines. It is important for patients with HF to be diagnosed correctly and early. Upon diagnosis, it is crucial that these patients are prescribed the correct medications with the optimal dosing to prevent the HF from advancing to higher stages. The stages of this disease per the American College of Cardiology are stage A , stage B , stage C and stage D .¹
When it comes to the disease severity, the categories include²:
- Preserved ejection fraction 50%
- Mildly reduced 40% to 49%
- Moderately reduced 30% to 39%
- Severely reduced 30%
- HF improved ejection fraction
Saro Arakelians, PharmD, is vice president of pharmacy operations at a pharmacy in the Los Angeles, California, area.
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Treatment Switching To Sacubitril/valsartan
Following a 48-hour ACE-i washout period , patients were initiated on sacubitril/valsartan at a dose according to the dose of ACE-i or ARB. Clinic visits to optimise treatment were scheduled bimonthly with slow uptitration of sacubitril/valsartan, with careful monitoring of side effects, heart rate, blood pressure and biochemistry. Titration continued until the patient either was taking the maximum recommended dose or reported side effects. Other evidence/guideline-based medications were continued where possible but, in some cases, were reduced to initiate sacubitril/valsartan.
Esc Clinical Practice Guidelines
The aim of this ESC guideline is to help health professionals manage people with heart failure according to the best available evidence. Fortunately, we now have a wealth of clinical trials to help us select the best management to improve the outcomes for people with HF for many, it is now both preventable and treatable. This guideline provides practical, evidence-based recommendations. The format of the previous 2016 ESC HF Guidelines was revised to make each phenotype of HF stand-alone in terms of its diagnosis and management. The therapy recommendations mention the treatment effect supported by the class and level of evidence and are presented in tables. In this guideline, we have decided to focus on the diagnosis and treatment of HF, not on its prevention.
Guidelines and related materials are for use by individuals for personal or educational purposes. No commercial use is allowed. Re-use permission must be correctly obtained .
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Heart Failure Guideline Update Puts Trust In Entresto
The American College of Cardiology, American Heart Association, and Heart Failure Society of America recently updated guidelines for pharmacological heart failure treatment, focusing specifically on 2 new agents.
The American College of Cardiology , American Heart Association , and Heart Failure Society of America recently for pharmacological heart failure treatment, focusing specifically on 2 new agents: sacubitril/valsartan and ivabradine .
Entresto is a combination of a neprilysin inhibitor and an angiotensin II receptor blocker . Neprilysin is an endopeptidase that degrades several vasoactive peptides, including natriuretic peptides, bradykinin, and adrenomedullin.1 Inhibition of neprilysin leads to elevated levels of these compounds, countering the vasoconstriction and sodium retention that occurs during neurohormonal overactivation.2 In experimental studies, inhibition of the renin-angiotensin and neprilysin had effects superior to either approach alone.3
The PARADIGM-HF study was designed to determine whether Entresto was superior to enalapril in reducing mortality and frequency of hospitalizations in HF patients with reduced ejection fraction . It was a multicentered, parallel group, double-blind, phase 3, randomized, controlled trial that included 10,521 patients at 1043 clinical institutions in 47 countries over a 3-year period .4
The study included the following patients:
Key Points Regarding Entresto
References
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New Heart Failure Guidelines Could Boost Entresto
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US and European professional societies coordinated their announcement to reduce confusion for physicians and payers.
A new drug to treat heart failurethe angiotensin receptor-neprilysin inhibitor & mdash should replace current therapies for certain patients with mild to moderate heart failure, according to an updated recommendation from the leading professional medical groups in the United States and Europe.
Late Friday, theAmerican College of Cardiology , the American Heart Association , and the Heart Failure Society of America published an update in the Journal of the American College of Cardiology . The update was timed to coordinate with similar guidance from the European Society of Cardiology an editorial in JACC said the coordinated effort is designed to promote optimal care for all patients with all forms of cardiovascular disease, to improve outcomes and enhance quality of life around the world.1,2
In heart failure , the heart muscle weakens, causing inadequate pumping of blood through the body. Patients with this condition experience shortness of breath, chronic coughing, loss of appetite, and they can experience cognitive symptoms.
The societies gave Entresto a Class I recommendation, the highest available, based on evidence from the 2014 PARADIGM trial, which found a 20% reduction in the composite endpoint of CV death or HF hospitalization.
For coverage of the recent 65th Scientific Sessions of the ACC, click here.
References
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Acc Issues Updated Guidance For Managing Patients With Hfref
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The ACC has released an updated Expert Consensus Decision Pathway providing guidance and recommendations on streamlining clinical care to achieve optimal outcomes for patients with heart failure with reduced ejection fraction . The document, published Jan. 11 in the Journal of the American College of Cardiology, is an update to the 2017 ACC Expert Consensus Decision Pathway For Optimization of Heart Failure Treatment.
Figure
Led by Chair Thomas M. Maddox, MD, MSc, FACC, and Vice Chair James L. Januzzi, Jr., MD, FACC, the Pathway aims to address 10 “pivotal” issues that remain unresolved in clinical guidelines related to how to implement guideline-directed medical therapy how to address specific challenges like referral, care coordination, specific patient cohorts, etc. and how to manage areas of increasing complexity, comorbidities and palliative care.
According to Maddox, Januzzi, et al., new therapies for HFrEF have emerged that expand the armamentarium for the treatment of patients with HFrEF since the original Pathway was published in 2017. As a result, the updated Pathway incorporates two new recommendations for patients with HFrEF, including the up-front use of sacubitril/valsartan without an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker pre-treatment. The second recommendation is for the use of a sodium-glucose cotransporter-2 inhibitor for care of patients with HFrEF, with or without diabetes.
New Hf Guidelines Feature ‘quad’ Therapy Tweaked Terminology
The new heart failure guidelines released this week by three North American societies had a lot of catching up to do given the significant, even paradigm-shifting, additions to available treatment options in the last few years.
The landscape now includes both new and repurposed drug therapies that benefit almost without regard to ejection fraction , and evidence-based urgency to engage patients early on with at least four core medication classes, so-called quadruple therapy.
The guideline document offers a roadmap for navigating those key issues and many others and uses some creative tactics. They include the introduction of generalist-friendly labels for the traditional but obscurely named four stages of HF severity that, it is hoped, will have wider reach and expand the use of effective therapies.
It introduces additional disease-staging terminology that characterizes the syndrome as a continuum:
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“At risk for HF” for stage A, applied to asymptomatic patients with risk factors such as diabetes or hypertension but no known cardiac changes
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“Pre-HF” for stage B, which adds cardiac structural changes or elevated natriuretic peptides, still in the absence of symptoms
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“Symptomatic HF” for stage C, that is, structural disease with current or previous symptoms
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“Advanced HF” for stage D, characterized by severe debilitating symptoms or repeated hospitalizations even with guideline-directed medical therapy
J Am Coll Cardiol. Published online April 1, 2022. Full text
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Delve Further Into The Careme Uk Partnership Algorithm For Optimisation Of Chronic Hfref Patients And First
Reduce the risk of death by starting with ENTRESTO and adding therapies subsequently5
Prescribing ENTRESTO as first choice helps to protect more moments that matter for patients and their loved ones, by improving limitations in physical and social activities and HRQoL in comparison to patients treated with enalapril.6,7
In HFrEF patients, drug combinations were more effective in reducing all-cause mortality than the same drugs administered individually.5,8
Subsequent addition of the 4 pillar approach resulted in a cumulative RR in all-cause mortality at 24 months5
Comparisons between drug classes should not be drawn.
This is a decision analytical model study applied on the total US eligible HF population . The magnitude of mortality reduction for SGLT2i was determined from the DAPA-HF trial.
A Review Of Treatment Options Guidelines For Heart Failure With Preserved Ejection Fraction
With the release of the 2022 AHA/ACC Guidelines for the Management of Heart Failure, patients with HFpEF now have a wider range of treatment options.
Heart failure with preserved ejection fraction , previously known as diastolic heart failure, is an impairment in the ventricular filling of blood characterized by a left ventricular ejection fraction of 50% or greater. HFpEF represents at least half of the population with heart failure and is associated with a high symptom burden, poor quality of life, and significant morbidity and mortality.1
According to the 2013 Heart Failure Guidelines, the primary recommended treatment option for patients with HFpEF were diuretics to improve symptom management. Angiotensin receptor blockers were also included in the guidelines to help decrease hospitalization, although they were a weak recommendation due to conflicting evidence.2 Additionally, the 2017 Focused Update of the 2013 Guidelines included a new, weak recommendation of mineralocorticoid receptor antagonists to decrease hospitalizations.3 With the release of the 2022 AHA/ACC Guidelines for the Management of Heart Failure, patients with HFpEF now have a wider range of treatment options.1 A timeline of these updates is included in Figure 1.
References
2. Yancy C, Jessup M, Bozkurt B, et al. ACCF/AHA Guideline for the Management of Heart Failure. Circulation. 2013 128:240-327.
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Entrestos Role In Heart Failure Guidelines
Brittany Raymond, PharmDEssentia Health
The American College of Cardiology along with American Heart Association and Heart Failure Society of America have updated the 2013 ACC/AHA Guideline for the Management of Heart Failure, which includes recommendations on Entrestos® place in therapy.
Entresto® is an angiotensin receptor-neprilysin inhibitor . Neprilysin is an enzyme that degrades natriuretic peptides, bradykinin, and other vasoactive peptides. By inhibiting angiotensin and neprilysin, Entresto® causes vasodilation, natriuresis, aldosterone suppression, and antifiboris. However, the use of this ARNI is associated with the risk of hypotension and renal insufficiency and may lead to angioedema in some patients. In one large, randomized clinical trial , Entresto® was compared with enalapril and found to be superior in reducing the risks of cardiovascular death or hospitalization by 20% in symptomatic patients diagnosed with heart failure with reduced ejection fraction .
Entresto® is approved for patients in NYHA Class II-IV HFrEF. Previous guidelines only included an angiotensin converting enzyme inhibitor or angiotensin receptor blocker as appropriate therapies to inhibit the renin-angiotensin system and therefore reduce morbidity and mortality A). Now guidelines recommend using an ACEI, ARB ), or ARNI to reduce morbidity and mortality.
References:
See How Starting With Entresto Is As Simple As Starting With An Acei 910
ENTRESTO is indicated in adult patients for the treatment of symptomatic chronic heart failure with reduced ejection fraction.9
Please click here for safety information
*CaReMe UK Partnership is a collaboration between the British Cardiovascular Society, the Renal Association, the Association of British Clinical Diabetologists, the Primary Care Cardiovascular Society and the Primary Care Diabetes Society.DISCLAIMER: This is a US guideline and should not be used to guide treatment decisions in the UK.Analysis of 2,132,800 patients with HFrEF and NYHA class II-IV heart failure.§Treatment should not be initiated if the serum potassium level is > 5.4 mmol/l. Use of sacubitril/valsartan may be associated with an increased risk of hyperkalaemia, although hypokalaemia may also occur. Monitoring of serum potassium is recommended, especially in patients who have risk factors such as renal impairment, diabetes mellitus or hypoaldosteronism or who are on a high potassium diet or on mineralocorticoid antagonists. If patients experience clinically significant hyperkalaemia adjustment of concomitant medicinal products, or temporary downtitration or discontinuation is recommended. If serum potassium level is > 5.4 mmol/l discontinuation should be considered.¶ENTRESTO contains valsartan, and therefore should not be co-administered with another ARB-containing product. Stop using an ACE inhibitor for 36 hours before starting ENTRESTO.9
References:
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Entresto Is Top Hfref Treatment Recommendation In Updated Acc Guidelines
Treatment optimization for heart failure with reduced ejection fraction is the focus of the American College of Cardiologys 2021 update to its 2017 Expert Consensus Decision Pathway on managing patients with the condition.
Treatment optimization for heart failure with reduced ejection fraction is the focus of the American College of Cardiology s 2021 update to its 2017 Expert Consensus Decision Pathway on managing patients with the condition, Journal of the American College of Cardiology.
One focus of the 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction is optimizing HFrEF treatment through expanded use of Entresto . It is now recommended ahead of all other renin-angiotensin-aldosterone system inhibitors.
New therapies for HFrEF have emerged that expand the armamentarium for the treatment of patients with HFrEF since the original Pathway was published in 2017, noted the ECDP authors in a statement. As a result, the updated Pathway incorporates two new recommendations for patients with HFrEF, including the up-front use of sacubitril/valsartan without an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker pre-treatment.
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Why Entresto Is A Winner For Heart Failure
Two new analyses have further cemented Entresto’s place in heart failure therapy.
The tide started to turn when the American College of Cardiology /American Heart Association released a 2016 guideline update focused on new pharmacological therapies for heart failure. In the guideline, Entresto received a class I recommendation for patients with chronic symptomatic HF with a reduced EF who tolerate an angiotensin converting enzyme inhibitor or angiotensin receptor blocker to further reduce morbidity and mortality. In other words, Entresto is now considered the cornerstone of treatment for HF patients with reduced EF.
About a month after the guidelines release, 2 new analyses further cemented Entrestos place in HF therapy.3,4
The first analysis quantified the projected gains in deaths prevented or postponed with comprehensive implementation of Entresto therapy in patients with HF and reduced EF. Eligibility was based on the population of patients with HF covered under current Entresto product labeling, while the magnitude of mortality reduction was determined by the PARADIGM-HF trial. The number needed to treat , standardized to 12 months, was used to calculate the number of potential lives saved per year with Entresto therapy.3
The total US prevalence of HF is 5.7 million cases, and about half of these patients have a left ventricular EF of < 40%. However, some patients may not be candidates for Entresto because of disease state severity or contraindications/intolerance.
Two New Drugs Added To Heart Failure Guidelines
Please note: This article was published more than two years ago, so some information may be outdated. If you have questions about your health, always contact a health care professional.
A pair of heart failure drugs approved last year by the Food and Drug Administration have made their way into new treatment guidelines. The American College of Cardiology, American Heart Association and Heart Failure Society of America on Friday released that add Corlanor and Entresto .
In an unprecedented move, the release was timed to coincide with the larger release of the European Society of Cardiologys heart failure guidelines.
The two medications represent the dawning of a new chapter in heart failure treatment, said Clyde W. Yancy, M.D., chair of the U.S. guidelines writing committee and chief of cardiology at Northwestern Universitys Feinberg School of Medicine in Chicago.
We deemed the importance of these two agents and, importantly, instructions for use to be top-of-mind considerations for patients with heart failure and practitioners who treat them, he said. These new treatments are not for every patient with heart failure but, when used correctly, substantial benefits are possible.
Entresto represents an evolution in heart failure treatment, according to Yancy. It replaces, he said, what was formerly considered part of the foundation in treating heart disease and heart failure: the use of angiotensin-converting enzyme, or ACE, inhibitors.
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