3 | Special Topic Supplement: Heart Failure
pair of heart failure (HF) drugs approved
last year by the Food and Drug
Administration have made their way
into updated treatment guidelines. The
American College of Cardiology, American
Heart Association and Heart Failure Society of America
have updated their guidelines to include ivabradine
(Corlanor) and valsartan/sacubitril (Entresto ).
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 University’s 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.”
Ivabradine and valsartan/sacubitril are very different
compounds. Ivabradine works by slowing the heart rate,
while valsartan/sacubitril works to relax blood vessels,
allowing better blood flow, and decreased counterproductive
stress on the heart.
Doctors might prescribe ivabradine to symptomatic,
stable HF patients whose resting heart rates are 70 beats
per minute or higher, despite being on the highest dose
the patient can tolerate of traditional beta blocker therapy
designed to slow the heart rate. In these patients a resting
heart rate of 70 beats a minute or faster may increase
the risk of hospitalization. Therefore, adding ivabradine to
beta blocker therapy can better control heart rate and help
prevent hospitalizations, Yancy said.
Valsartan/sacubitril 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.
“Recent compelling data demonstrate that if you treat
patients in a traditional manner with therapy, which includes
the ACE inhibitor, and then replace that ACE inhibitor with
this new combination, remarkably, patients don’t just do a
little bit better, they do substantially better,” he said.
Cardiologist Mathew Maurer, M.D., uses these new
medicines when treating heart failure patients at New York-
Presbyterian/Columbia University Medical Center.
“Particularly, I think, that the data is stronger — as the
guidelines reflect — for valsartan/sacubitril than it is for
ivabradine,” said Maurer, medical director of The HCM
Center at New York-Presbyterian. Maurer was not involved
in writing the updated guidelines but conducted research on
An estimated 5. 7 million Americans have heart failure,
a progressive condition in which the heart is unable to
efficiently pump blood.
“There has been a dearth of new therapies for
patients with chronic systolic heart failure,” Maurer said.
“With these therapies we’ve actually advanced the
clinical care a tremendous amount and created hope
for patients with chronic systolic heart failure that their
outcomes could be improved, their quality of life better
and, ideally, they can spend more time out of hospital,
highly functional and alive.”
Source: American Heart Association News
TWO NEW DRUGS ADDED TO
HEART FAILURE GUIDELINES