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Managing Heart Failure

Authors

Eileen Koutnik-Fotopoulos

San Diego—Heart failure (HF) is the leading cause of rehospitalization in both men and women on Medicare and the underlying cause of >58,000 US deaths in 2011, according to the Centers for Disease Control and Prevention.

“HF is worse than the prognosis for cancer as 50% of people diagnosed will die within 5 years. [HF is] a bad prognosis to carry,” said Joseph S. Alpert, MD, professor of medicine, University of Arizona School of Medicine, director of the coronary care unit, University of Arizona Medical Center, who addressed attendees during a science and innovation theater covering HF at the AMCP meeting. Amgen sponsored the event.

Shortly after the product theater, on April 15, 2015, Amgen received FDA approval of its oral HF drug. Ivabradine is indicated to reduce the risk of hospi- talization for worsening HF in patients with stable, symptomatic chronic HF with left ventricular ejection fraction (LVEF) ≤35%, who are in sinus rhythm with resting heart rate ≥70 beats per minute (bpm) and either are on maximally tolerated doses of beta-blockers or have a contraindication to beta-blocker use, according to an Amgen news release.

Dr. Alpert provided some statistics on the epidemiology and prevalence of HF. Approximately 25% of hospitalized patients with HF are re-admitted within 30 days of discharge. Risk factors for HF include atherosclerosis, hyperten- sion, diabetes, advanced age, obesity, alcoholism, and metabolic syndrome.

Elevated heart rate is an established risk factor for cardiovascular mortality and morbidity in a variety of cardiovascular diseases, according to the CHARM [Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity] study, which looked at HF and cardiovascular outcomes and which was cited by Dr. Alpert [J Am Coll Cardiol. 2012;59(20):1785-1795]. The findings showed resting heart rate was an important predictor of mortality and cardiovascular outcomes in patients with stable chronic HF without atrial fibrillation, regardless of LVEF or beta-blocker use. 

Dr. Alpert highlighted a separate study that focused on patients undergoing implantable cardioverter-defibrillator (ICD) implantation [Circulation. 2009;120(21):2040-2050]. INTRIN- SIC RV [Inhibition of Unnecessary RV Pacing with AV Search Hysteresis in ICDs] was a randomized, controlled trial of patients who received ICDs. The researchers tested the hypothesis that the mean intrinsic (unpaced) heart rate, based on data recorded over the entire follow-up, predicted total mortality and HF hospitalization. The results showed that higher intrinsic heart rate was associated with greater risk of achieving the primary end point of death or HF hospitalization (P<0.001). Of patients with a mean heart rate <75 bpm, 5.8% died or were hospitalized for HF, whereas 20.9% with a mean HF >90 bpm achieved the same end point, a 3.6-fold difference (P<0.0001).

Dr. Alpert suggested clinicians review the 2013 American College of Cardiology Foundation/American Heart Association) guidelines for the management of HF, which provides a comprehensive manual to the evaluation and management of HF patients.—Eileen Koutnik-Fotopoulos 

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