Heart failure in the last year: progress and perspective

Abstract

Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM-HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA-HF and EMPEROR-Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65-0.85; P < 0.001 and HR 0.75; 95% CI 0.65-0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82-0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.

Keywords: Acute heart failure; Diagnosis; HFrEF; Heart failure; HfpEF; Treatment.

Conflict of interest statement

D.T. and M.A. declare that they have no conflict of interest. M.S.A. has received personal fees from Servier, outside the submitted work. SvH has been a paid consultant for and/or received honoraria payments from Bayer, Boehringer Ingelheim, BRAHMS, Chugai, Grünenthal, Helsinn, Hexal, Novartis, Pharmacosmos, Respicardia, Roche, Sorin, and Vifor. SvH owns shares in Actimed. SvH reports research support from IMI and the German Center for Cardiovascular Research (DZHK). M.M. has received in the last 3 years personal honoraria from Abbott Vascular, Actelion, Amgen, AstraZeneca, Bayer, LivaNova, Servier, Vifor Pharma, and Windtree Therapeutics for participation to trials' committees or advisory boards and speaker honoraria from Abbott Vascular, Edwards Therapeutics, and Servier.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Figures

Figure 1

Combined survival rates for people with heart failure over time. Adapted from Jones et al. 11

Figure 2

The four main domains—clinical, physical–functional, cognitive–psychological, and social—defining Heart Failure Association Frailty Score. Reversible and/or treatable variables are identified by asterisks. ADL, activities of daily living; HF, heart failure; IADL, instrumental activities of daily living. From Vitale et al. 72

Figure 3

Positive trials in the treatment of heart failure with reduced ejection fraction from 1986 to 2020. Modified from McMurray. 168

Figure 4

Classification based on congestion/hypoperfusion status assessed by clinical examination performed at admission and discharge. Classification at discharge was used in 7448 patients discharged alive. From Chioncel et al. 281