Heart Failure Treatment Guidelines: More Medication Options
Updated heart failure treatment guidelines add new medications, giving doctors and patients better choices.
By Kathleen Doheny
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If you have heart failure, you now have more treatment choices than ever, says Clyde Yancy, MD, chief of the division of medicine-cardiology at Northwestern University's Feinberg School of Medicine in Chicago.
Dr. Yancy chaired a group of representatives from the Heart Failure Society of America, the American College of Cardiology, and the American Heart Association that updated heart failure treatment guidelines in May 2019 to include two new drugs. The drugs, Entresto (sacubitril and valsartan) and Corlanor (ivabradine), were both approved by the Food and Drug Administration (FDA) in 2015 as safe and effective treatments for heart failure.
Yancy, who has treated patients with heart failure for more than 25 years, says the addition of the two new drugs "is about as much hope as I've been able to convey to patients. And nothing is more important than that when you're caring for people who have despair over the diagnosis."
About 5.1 million people in the United States have heart failure, according to the Centers for Disease Control and Prevention (CDC). When this condition occurs, the heart is unable to pump enough blood to meet the needs of the body.
Heart failure typically worsens over time as the heart’s pumping ability continues to decline. Heart attacks and high blood pressure increase your risk for heart failure. Those affected can have trouble breathing and feel tired, weak, and short of breath when going about everyday activities.
About half of those who develop the condition die within five years of their diagnosis, according to the CDC. Treatments include cutting back on dietary salt, getting some exercise each day, and taking medication. Some patients will go on to need a heart transplant to survive.
Who Is a Candidate for New Treatments?
The updated treatment guideline revises recommendations issued in 2013 and only addresses new pharmacological treatments. A full update on heart failure treatment is underway, say doctors.
But the new drugs are not for everyone with heart failure, experts say.
"They aren't going to be right for every patient," notes Michael M. Givertz, MD, medical director of the heart transplant and mechanical circulatory support program at Brigham and Women's Hospital in Boston, who represented the Heart Failure Society of America at the meeting. "We don't want the news to be that everyone with heart failure should go to their doctor and say, 'Give me Entresto, give me Corlanor,''' he says.
Under the updated guidelines, the two new drugs have been added to the list of options for those with a diagnosis of “Stage C heart failure with a reduced ejection fraction.” Until now, treatment options for this diagnosis have included several types of heart failure drugs, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), aldosterone receptor antagonists, beta blockers, and others.
Corlanor works by blocking a salt channel in the primary pacemaker of the heart, reducing heart rate, while Entresto works by relaxing blood vessels and reducing the buildup of sodium and fluid in your body.
Corlanor was approved by the FDA in April 2015. In a study of more than 6,500 people who took either Corlanor or a placebo, fewer patients taking Corlanor were hospitalized for worsening heart failure. In the study, the most common side effects of Corlanor included excess slowing of the heart rate, elevated blood pressure, a heart rhythm problem know as atrial fibrillation, and transient vision problems with flashes of light.
Entresto was FDA-approved in July 2015. In a study of more than 8,000 patients, the drug was shown to lower the rate of both cardiovascular death and hospitalizations related to heart failure compared to another drug, Vasotec (enalapril). The most common side effects of Entresto included low blood pressure, a high blood potassium level, and problems with kidney function. Allergic reactions, such as facial or lip swelling, were also reported; experts say emergency treatment is crucial if you experience any allergies or breathing issues.
Insurance may help cover the cost of new heart failure drugs, which can be pricey. A month's supply of Corlanor is about 0, as is the monthly cost for the lowest dose of Entresto. The companies that make the drugs may offer patient assistance programs to help lower the cost of the new heart failure drugs.
When they’re used in properly selected patients, medications for heart failure can help keep people out of the hospital and improve quality of life, says cardiologist David A. Friedman, MD, chief of heart failure services at Northwell Health Long Island Jewish Valley Stream Hospital in Valley Stream, New York.
"It definitely is an exciting time in the heart failure world as we start using newer treatment options in addition to more traditional anti-heart failure pharmacologic strategies,” says Dr. Friedman.
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