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Current Advances in Optimal Medical Therapy for Heart Failure
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Current Advances in Optimal Medical Therapy for Heart Failure

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 September 2024) | Viewed by 7739

Special Issue Editor

Dr. Teruhiko Imamura

E-Mail Website
Guest Editor
Second Department of Internal Medicine, University of Toyama, Toyama 9300194, Japan
Interests: heart failure; heart transplantation; cardiology; cardiothoracic surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are currently in the era of the heart failure pandemic. The number of heart failures is increasing and the severity of heart failure is advancing. However, novel medications have been introduced, including the “fantastic four”. Nevertheless, therapeutic strategies regarding how to appropriately use these medications in real-world clinical practice remain unestablished. We often encounter elderly heart failure patients with multiple comorbidities. Large-scale randomized control trials do not necessarily provide us with appropriate answers regarding how to manage such patients. Now is the time to establish therapeutic strategies using novel medications to treat heart failure patients in real-world clinical practice. All original articles or systemic reviews on this topic related to current advances in heart disease are welcome and highly encouraged for submission.

Dr. Teruhiko Imamura
Guest Editor

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Keywords

  • heart failure
  • hemodynamics
  • hypertension
  • cardiac function
  • heart disease

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Published Papers (5 papers)

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Research

17 pages, 1633 KiB  
Article
Validation of a New Scoring Method to Assess the Efficacy of Rapid Initiation and Titration of Combination Pharmacotherapy for Patients Hospitalized with Acute Decompensated Heart Failure with Reduced and Mildly Reduced Ejection Fraction
by Takaaki Asano, Yoshio Maeno, Masataka Nakano, Masataka Taguri, Masaki Miyasaka, Daisuke Nakai, Itaru Miyazaki, Takahito Nasu, Shuzou Tanimoto, Naoki Masuda, Yoshihiro Morino, Takaaki Isshiki and Nobuhiko Ogata
J. Clin. Med. 2024, 13(10), 2775; https://doi.org/10.3390/jcm13102775 - 8 May 2024
Viewed by 963
Abstract
Background: Despite the encouragement of early initiation and titration of guideline-directed medical therapy (GDMT) for the treatment of heart failure (HF), most patients do not receive an adequate type and dose of pharmacotherapy in the real world. Objectives: This study aimed [...] Read more.
Background: Despite the encouragement of early initiation and titration of guideline-directed medical therapy (GDMT) for the treatment of heart failure (HF), most patients do not receive an adequate type and dose of pharmacotherapy in the real world. Objectives: This study aimed to determine the efficacy of titrating composite GDMT in patients with HF with reduced and mildly reduced ejection fraction and to identify patient conditions that may benefit from titration of GDMT. Methods: This was a two-center, retrospective study of consecutive patients hospitalized with acute decompensated heart failure (ADHF). Patients were classified into two groups according to a scoring scale determined by combination and doses of four types of HF agents (ACEis/ARBs/ARNis, BBs, MRAs, and SGLT2is) at discharge. A score of 5 or greater was defined as titrated GDMT, and a score of 4 or less was regarded as sub-optimal medical therapy (MT). Results: A total of 979 ADHF patients were screened. After 553 patients were excluded based on exclusion criteria, 426 patients (90 patients in the titrated GDMT group and 336 patients in the sub-optimal MT group) were enrolled for the analysis. The median follow-up period was 612 (453–798) days. Following statistical adjustment using the propensity score weighting method, the 2-year composite endpoint (composite of cardiac death and HF rehospitalization) rate was significantly lower in the titrated GDMT group, at 19%, compared with the sub-optimal MT group: 31% (score 3–4 points) and 43% (score 0–2 points). Subgroup analysis indicated a marked benefit of titrated GDMT in particular patient subgroups: age < 80 years, BMI 19.0–24.9, eGFR > 20 mL/min/1.73 m2, and serum potassium level ≤ 5.5 mmol/L. Conclusions: Prompt initiation and dose adjustment of multiple HF medications, with careful monitoring of the patient’s physiologic and laboratory values, is a prerequisite for improving the prognosis of patients with heart failure. Full article
(This article belongs to the Special Issue Current Advances in Optimal Medical Therapy for Heart Failure)
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10 pages, 930 KiB  
Article
A Prospective Randomized Controlled Clinical Study to Investigate the Efficacy and Safety of Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors in Non-Dialysis Patients with Chronic Heart Failure and Renal Anemia Switched from Continuous Erythropoietin Receptor Activator Treatment
by Akira Sezai, Masanori Abe, Takashi Maruyama, Makoto Taoka, Hisakuni Sekino and Masashi Tanaka
J. Clin. Med. 2024, 13(10), 2764; https://doi.org/10.3390/jcm13102764 - 8 May 2024
Viewed by 1673
Abstract
Background/Objectives: Chronic kidney disease (CKD) and anemia are independent prognostic factors for heart failure. In recent years, hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors have become available for the treatment of renal anemia. This prospective randomized controlled study aimed to investigate the effects of [...] Read more.
Background/Objectives: Chronic kidney disease (CKD) and anemia are independent prognostic factors for heart failure. In recent years, hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors have become available for the treatment of renal anemia. This prospective randomized controlled study aimed to investigate the effects of switching from a continuous erythropoietin receptor activator (CERA) to one of four HIF-PH inhibitors in patients with chronic heart failure and renal anemia. Methods: Forty patients were randomized by the envelop method to receive treatment with roxadustat, daprodustat, vadadustat, or molidustat. The primary endpoint was the change in the hemoglobin (Hb) level. Secondary endpoints included changes in erythropoietin, changes in free T3, free T4, and thyroid-stimulating hormone (TSH), adverse effects, and drug dose increases and decreases. This study was preregistered in the University Hospital Medical Information Network Clinical Trials Registry (study ID: UMIN000041651). Results: We found no statistically significant difference between Hb levels with HIF-PH inhibitors and CERA, but at month 6, the Hb level was significantly higher with roxadustat than with vadadustat and daprodustat. Erythropoietin decreased significantly after switching to HIF-PH inhibitors. HIF-PH inhibitors had various significant effects on free T3, free T4, and TSH. No adverse events occurred. The doses of some drugs had to be increased or decreased. Conclusions: In patients with heart failure and renal anemia receiving CERA, Hb, NT-ProBNP, and renal function were similar after switching from CERA to HIF-PH inhibitors. The individual HIF-PH inhibitors appear to have different effects on anemia and thyroid function. However, because this was a single-center study with a limited sample size, the efficacy and potential limitations of HIF-PH inhibitors need to be further clarified. Full article
(This article belongs to the Special Issue Current Advances in Optimal Medical Therapy for Heart Failure)
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11 pages, 2049 KiB  
Article
Differential Prognostic Impact of Risk-Prediction Models for Heart Failure in Acute Myocardial Infarction: The Original and Revised Heart Failure Time-Points
by Kazunari Asada, Yuichi Saito, Hiroki Goto, Hiroaki Yaginuma, Takanori Sato, Osamu Hashimoto, Hideki Kitahara and Yoshio Kobayashi
J. Clin. Med. 2024, 13(9), 2501; https://doi.org/10.3390/jcm13092501 - 24 Apr 2024
Cited by 2 | Viewed by 1007
Abstract
Background: We previously developed a risk-scoring system for heart failure (HF) in patients with acute myocardial infarction (MI), namely “HF time-points (HFTPs)”. In the original HFTPs, the presence of HF on admission, during hospitalization, and at short-term follow-up was individually scored. This study [...] Read more.
Background: We previously developed a risk-scoring system for heart failure (HF) in patients with acute myocardial infarction (MI), namely “HF time-points (HFTPs)”. In the original HFTPs, the presence of HF on admission, during hospitalization, and at short-term follow-up was individually scored. This study examined whether the revised HFTPs, with additional scoring of previous HF, provide better predictivity. Methods: This multicenter registry included a total of 1331 patients with acute MI undergoing percutaneous coronary intervention. HF was evaluated at four time-points before and after acute MI onset: (1) a history of HF; (2) elevated natriuretic peptide levels on admission; (3) in-hospital HF events; and (4) elevated natriuretic peptide levels at a median of 31 days after the onset. When HF was present at each time-point, one point was assigned to a risk scoring system, namely the original and revised HFTPs, ranging from 0 to 3 and from 0 to 4. The primary endpoint was a composite of cardiovascular death and HF rehospitalization after discharge. Results: Of the 1331 patients, 65 (4.9%) had the primary outcome events during a median follow-up period of 507 (interquartile range, 335–1106) days. The increase in both original and revised HFTPs was associated with an increased risk of the primary outcomes in a stepwise fashion with similar diagnostic ability. Conclusions: The original and revised HFTPs were both predictive of long-term HF-related outcomes in patients with acute MI undergoing percutaneous coronary intervention. Yet, the original HFTPs may be sufficient to estimate HF risks after MI. Full article
(This article belongs to the Special Issue Current Advances in Optimal Medical Therapy for Heart Failure)
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13 pages, 2506 KiB  
Article
Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure with Malnutrition, Frailty, Sarcopenia, or Cachexia
by Yu Horiuchi, Masahiko Asami, Kazuyuki Yahagi, Asahi Oshima, Yuki Gonda, Daiki Yoshiura, Kota Komiyama, Hitomi Yuzawa, Jun Tanaka, Jiro Aoki and Kengo Tanabe
J. Clin. Med. 2024, 13(6), 1670; https://doi.org/10.3390/jcm13061670 - 14 Mar 2024
Viewed by 1569
Abstract
(1) Background: In patients with heart failure (HF) and impaired nutritional status or decreased muscle mass, sodium-glucose cotransporter-2 inhibitors (SGLT2is) may worsen these conditions and result in poor prognosis, especially worsening of frailty. We aimed to investigate the relationship between SGLT2is and [...] Read more.
(1) Background: In patients with heart failure (HF) and impaired nutritional status or decreased muscle mass, sodium-glucose cotransporter-2 inhibitors (SGLT2is) may worsen these conditions and result in poor prognosis, especially worsening of frailty. We aimed to investigate the relationship between SGLT2is and clinical outcomes, including frailty-related events, in patients with HF and malnutrition, frailty, sarcopenia, or cachexia. (2) Methods: In this retrospective observational cohort study, a global federated health research network provided data on patients with HF and malnutrition, frailty, sarcopenia, or cachexia from January 2016 to December 2021. We investigated the incidence of the composite endpoint of death or frailty-related events within one year. (3) Results: Among 214,778 patients included in the analysis, 4715 were treated with SGLT2is. After propensity score matching, 4697 patients in the SGLT2is group were matched with 4697 patients in the non-SGLT2is groups. The incidence of the composite endpoint, mortality, and frailty-related events was lower in the SGLT2is group than in the non-SGLT2is group (composite endpoint, 65.6% versus 77.6%, p < 0.001; mortality, 17.4% vs. 35.5%, p < 0.001; frailty-related events, 59.4% vs. 64.3%, p < 0.001). (4) Conclusions: Patients with HF and malnutrition, frailty, sarcopenia, or cachexia had a high incidence of death and frailty-related events. SGLT2is were associated with a lower incidence of these events. Full article
(This article belongs to the Special Issue Current Advances in Optimal Medical Therapy for Heart Failure)
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14 pages, 2474 KiB  
Article
PR Interval as a Novel Therapeutic Target of Ivabradine Therapy—Prognostic Impact of Ivabradine-Induced PR Prolongation in Heart Failure Patients
by Riona Yamamoto, Naoya Kataoka, Teruhiko Imamura, Toshihide Izumida and Koichiro Kinugawa
J. Clin. Med. 2024, 13(2), 510; https://doi.org/10.3390/jcm13020510 - 16 Jan 2024
Viewed by 1399
Abstract
Background: Ivabradine reduces heart rate by inhibiting the “funny current” expressed on the sinoatrial node and improves mortality and morbidity in patients with systolic heart failure and sinus tachycardia. The funny current is known to be expressed also on the atrioventricular node according [...] Read more.
Background: Ivabradine reduces heart rate by inhibiting the “funny current” expressed on the sinoatrial node and improves mortality and morbidity in patients with systolic heart failure and sinus tachycardia. The funny current is known to be expressed also on the atrioventricular node according to experimental studies. However, the impact of ivabradine on PR interval remained unknown. Methods: Patients with a left ventricular ejection fraction of less than 50% who received 1 month of ivabradine were screened. Electrocardiographic and echocardiographic data, particularly concerning heart rate, the PR interval, and trans-mitral flow pattern, were collected at baseline and 1-month follow-up. The primary endpoint was defined as the composite of cardiovascular death and hospital readmission for worsening heart failure following ivabradine administration. Results: In the cohort of 29 enrolled patients (median age: 66 years, 62% male), the median baseline heart rate was 86 beats per minute and the median PR interval was 168 milliseconds. Following ivabradine administration, a significant decrease of 20 beats per minute in the heart rate and a significant increase of 24 milliseconds in the PR interval were observed. The truncated interval of the A-wave, detected in the trans-mitral flow, consistently demonstrated a negative correlation with the PR interval both before and after the administration of ivabradine. During a median of 1.8 years of follow-up, six patients reached the primary endpoint. A combination of heart rate reduction and PR prolongation following ivabradine administration, both of which were independent factors associated with the primary endpoint (p < 0.05 for both), was associated with greater freedom from the primary endpoint compared with either/neither of them (p = 0.002). Conclusions: Ivabradine seems to prolong PR interval, which is a novel surrogate marker of favorable clinical outcomes in patients with systolic heart failure. This effect may be associated with the dynamics of the trans-mitral flow pattern, in conjunction with heart rate and the PR interval. Clinical implications of PR interval-guided ivabradine therapy remains the future concern. Full article
(This article belongs to the Special Issue Current Advances in Optimal Medical Therapy for Heart Failure)
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