Chronic heart failure is a frequent, debilitating, and fatal condition that impacts over five million people in the United States and results in about one million hospitalizations each year. With the death rate over five years, set at 50%, there is a huge need for advancements in the management of heart failure.
Correlation of Anemia with HF
Anemia is an increasingly common comorbidity in patients with chronic heart failure and has a poor prognosis. Inflammation, starvation, and renal failure have been suggested as possible causes of this relationship. This discovery has sparked great interest in anemia as a possible target for the treatment of heart failure.
Several research studies using recombinant human erythropoietin in the treatment of people with heart failure and anemia have shown encouraging results. Although these initial results are encouraging, the overall risk-benefit relationship of treatment for anemia is uncertain. More comprehensive studies of exercise tolerance and mortality are planned or ongoing.
Implanted Devices
Implanted devices like ICDs and biventricular pacemakers are becoming more used in heart failure treatment. Recent evidence has backed up a large increase in the usage of ICDs for lowering the death rate (sudden cardiac) of patients diagnosed with HD.
The Use of Nitrates
As for the nitrates and hydrazine treatment, there was excitement over the discovery of a treatment that is especially beneficial to a high-risk minority population. However, a later study of pooled VHeFT results found that the combination of isosorbide dinitrate and hydralazine was likely to be more effective in African American patients than Europeans.
Basic research data established a biological basis for these findings and found that African American patients had lower bioavailability of nitric oxide, which could be improved with the combination of hydralazine nitrate. The reservations about using skin color as a crude measure for the genetic and environmental factors are the more direct determinants of who may respond to certain treatments.
In African-Americans, more prevalent and less functioning variations of the nitric oxide synthase 3 gene explain the findings, which might aid in the selection of patients for beta-blocker medication. These findings suggest that pharmacogenetics may have a promising future in therapy discovery for heart failure.
Effective Management of HF
Aside from advancements in particular heart failure medicines, paradigms for implementing these treatments are also evolving. One of the most effective determinants of patient success is medication adherence. Significant research efforts have been spent on exploring illness management options, as they have been for other chronic diseases such as diabetes mellitus and asthma.
To reduce heart failure hospitalizations, such techniques rely on meticulous longitudinal treatment, which typically involves significant engagement by nurse clinicians. Although the results of trials testing such techniques have been mixed, the overall evidence shows that such therapies reduce hospitalization and may lower heart failure care expenditures.
The capacity to monitor physiologic parameters in ambulatory heart failure patients using data received from implanted devices may increase as device technology improves. Several key recent research has also looked at how to use established medication to its full potential.
Reviewing Relevant Studies for the Blockers of ACE
A significant amount of clinical research data indicates that angiotensin-converting enzyme inhibitors are the standard of care for patients with chronic heart failure associated with ventricular systolic dysfunction. Angiotensin receptor blockers block the effects of angiotensin II in a different way than ACE inhibitors and have several potential benefits.
While ACE inhibitors inhibit angiotensin II synthesis, ARBs directly antagonize angiotensin II receptors, suggesting theoretically more complete inhibition of angiotensin II effects. ARBs also have fewer unpleasant side effects, such as a persistent cough, and may be better tolerated than ACE inhibitors. The efficacy of ARB alone or in combination with ACE inhibitors in patients with heart failure has recently been studied in several landmark studies.
Individuals receiving an already optimized dose of an ACE inhibitor with the addition of candesartan experienced a statistically significant 15% reduction in the primary endpoint. Importantly, the CHARM study was the first large-scale evaluation of any drug in a significant cohort of patients with heart failure with preserved systolic function, where candesartan treatment showed no improvement in mortality but marginally reduced hospitalizations for heart failure.
Results from the CHARM and VALHeFT studies suggest that ARBs are well tolerated and should be used as first-line therapy in patients with heart failure who cannot tolerate ACE inhibitors. Patients with chronic heart failure and decreased left ventricular ejection fraction may benefit from ACE inhibitors and beta-blockers, while symptomatic patients may benefit from spironolactone or ARBs to further reduce morbidity and mortality.
These drugs minimize hospitalization for heart failure and appear to improve quality of life in people already taking ACE inhibitors, and candesartan reduces cardiovascular mortality.
What to Expect from the Management of Heart Failure in the Future?
First, individual treatments for heart failure will become more prevalent as cheaper technologies become available that can apply genetic and protein information to specific patients. Based on their knowledge of the pharmacological mechanism of action, the AHeFT study in Africa and America was one of the first of its kind. Identification of specific genetic traits or circulating biomarker levels can be used in the future to select therapies that are most likely to be effective for a given patient.
Second, the continued growth of implantable device indications, whether for the prevention of sudden cardiac death or cardiac resynchronization treatment, will undoubtedly continue. In addition to drugs supplied by these devices, their increasing use in heart failure patients will open up new possibilities for outpatient heart failure patients for continuous physiological monitoring.
Conclusion
Sudden cardiac death and heart failure are among the most common death causes in the United States. With that in mind, technological advancements and new studies on relevant pharmaceuticals are of utmost importance. These technologies will optimize the efficacy of currently available drugs and identify new therapeutic targets for future development.