Expanding Heart Failure Medication Choices

A 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 valsartan/sacubitril.

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

If heart failure is experienced by you or someone you care about, visit our Conditions page for our four-part series on heart failure.  

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