Heart Failure Treatment Insight From ACC.2021

Volume 3, Issue 3

This past weekend the American College of Cardiology convened its annual meeting in a virtual format. The amount of quality science that has been presented so far is simply staggering, necessitating that we dedicate multiple weeks of “Talking Therapeutics” to covering all the action. In this week’s installment, part 1, we explore the latest heart failure (HF) related content presented at last week’s ACC.21 virtual meeting.

Point 1: SGLT2 inhibitors appear to be wonder drugs

 By far the most exciting heart failure related publications are the SOLOIST-WHF and SCORED trials, which showed use of sotagliflozin in patients with both diabetes and HF significantly reduced the composite of total cardiovascular (CV) deaths, HF hospitalizations, and urgent visits for HF in patients with recent acutely decompensated HF. More importantly, the benefits were seen across the full range of ejection fraction, including HFpEF. While these findings need to be confirmed by the ongoing EMPA-Preserved study, these preliminary data are extremely exciting given the lack of effective therapies for pEF.

Point 2: Pirfenidone may also offer promise for HFpEF

Pirfenidone, a novel non-steroidal mineralocorticoid receptor antagonist, reduced myocardial fibrosis in patients with HFpEF, according to data from the early-phase PIROUETTE trial. These pre-clinical data are very exciting and offer hope that future clinical trials will show that pirfenidone may hold promise for a disease with limited therapeutic options.

Point 3: Entresto not helpful for advanced heart failure

The LIFE trial showed that combination sacubitril/valsartan did not reduce NT-proBNP or clinical outcomes among patients with advanced HFrEF and comorbidities. Overall, this trial is underpowered to evaluate clinical endpoints, but the findings suggest that in patients with advanced heart failure the focus should shift to non-drug therapies (ie, transplant or LVAD).

The one exception…

Point 4: Omecamptiv may be helpful for advanced heart failure

A new analysis from the GALACTIC-HF trial showed the novel selective cardiac myosin activator omecamtiv mecarbil produced a greater reduction in HF events in at-risk patients with lower baseline ejection fractions (LVEF<28%). These findings are meaningful as patients with more advanced disease tend to be refractory to traditional HF agents. If this medication is eventually approved for HF, and added opportunity for pharmacists may be created as omecamptiv will require therapeutic drug monitoring.

Dr Jennings is currently an Associate Professor of Pharmacy at Long Island University and the clinical pharmacist for the Heart Transplant and LVAD teams at New York- Presbyterian Hospital Columbia University Irving Medical Center.  He is an active researcher in his field, and he has published over 120 peer-reviewed abstracts and manuscripts, primarily focusing on the pharmacotherapy of patients under mechanical circulatory support. As a recognized expert in this area, he has been invited to speak at numerous national and international venues, including meetings in France, Saudia Arabia, and India. Finally, Dr Jennings has been active in professional organizations throughout his career. He is a fellow of the American College of Clinical Pharmacy, the American College of Cardiology, the Heart Failure Society of America, and the American Heart Association.  

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