Guidelines Aid in Management of Heart Failure, Associated Complications
Guideline-based management approaches can improve quality of care and outcomes for patients with heart failure (HF) and arrhythmic complications, according to a presentation given at the American Society of Health-System Pharmacists Midyear Clinical Meeting & Exposition (December 3-7, 2017; Orlando, FL).
Although HF management has improved over time, the disease is still associated with high morbidity and mortality rates, with projected increases of approximately 50% by 2030. Costs of HF management are projected to increase alongside the forecasted rise in diagnoses.
The introduction of treatment guidelines have addressed the use of biomarkers as diagnostic and prognostic tools, as well as newly available therapies and the management of HF with reduced ejection fraction (HFrEF), anemia, and hypertension.
James Tisdale, PharmD, BCPS, FAHA, FAPhA, FNAP, professor at Purdue University (Indianapolis, IN), and Jo E Rogers, PharmD, BCPS, FCCP, FNAP, FHFSA, FAHA, clinical associate professor at UNC Eshelman School of Pharmacy (Chapel Hill, NC), outlined how guidelines are now used in cardiac care management of HF.
As new therapies emerge for HFrEF, guideline updates have highlighted managing the underlying diseases associated with HF, including hypertension and atrial fibrillation (AF). First-line therapy indications include use of an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker plus beta blocker. Newly indicated therapies include the combined neprilysin/angiotensin receptor blocker sacubitril/valsartan in patients with chronic HFrEF, as well as ivabradine in patients with normal sinus rhythm and a heart rate greater than 70 beats per minute.
Guidelines for the management of hypertension, based on findings from the SPRINT trial, suggested a goal systolic blood pressure below 130 mmHg. Anemia management in patients with HF and iron deficiency recommended the use of intravenous iron to increase functional status and improve quality of life.
Patients with HF and AF face an increased risk for stroke and systemic embolism. Guidelines recommend similar management among patients with AF with or without HF if they have normal left ventricular function, centering around oral anticoagulation. However, HF patients with compromised renal functioning should receive appropriate adjustments to their non-vitamin K oral anticoagulants.
Ventricular arrhythmias—which can cause sudden cardiac death—are commonly seen in HF patients. Stable hospitalized patients can receive intravenous amiodarone, as well as procainamide and sotalol. “Patients with HF and a history of life-threatening arrhythmias or some with nonsustained venous thromboembolism or unexplained syncope require implantation of an implantable cardioverter-defibrilator,” Drs Tisdale and Rogers wrote.—Cameron Kelsall