In a guideline update published on May 20, 2016, the American College of Cardiology, the American Heart Association and the Heart Failure Society of America detail the groups’ recommendations for the use of two new heart failure medications.
This update to the 2013 ACCF/AHA Guideline for the Management of Heart Failure includes the addition of an angiotensin receptor-neprilysin inhibitor (ARNI) (valsartan/sacubitril), and a sinoatrial node modulator (ivabradine) to the list of treatment options for Stage C heart failure patients with a reduced ejection fraction. The previously determined drug options for these patients include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), aldosterone antagonists, beta blockers, the combination of isosorbide dinitrate and hydralazine and diuretics. The goal of all of these medications is to relax blood vessels, reduce (biological) stress and improve the function of the heart.
“Not every patient is a good candidate for every drug; these guidelines can help physicians decide who best fits which treatment,” said Clyde W. Yancy, MD, MSc, MACC, FAHA, FHFSA, professor of medicine and chief of cardiology at the Northwestern University Feinberg School of Medicine and chair of the writing committee. “This document details the benefits and risks of these new therapies so that patients at high risk can be directed towards alternative therapies.”
According to the new recommendations, a therapeutic regimen of an ACE inhibitor or ARB or ARNI along with a beta blocker and an aldosterone antagonist is the new recommended therapy for patients with chronic symptomatic heart failure with reduced ejection fraction. ARNIs should replace ACE inhibitors (or ARBs) when stable patients with mild-to-moderate heart failure on these therapies have an adequate blood pressure and are otherwise tolerating standard therapies well. ARNIs, however, should not be used with an ACE inhibitor and should not be used by patients with a history of angioedema.
Ivabradine may be beneficial in reducing heart failure hospitalizations in patients with symptomatic stable chronic heart failure with reduced ejection fraction who are receiving guideline-directed evaluation and management, including a beta blocker at a maximum tolerated dose, and who are in sinus rhythm with a heart rate of 70 beats per minute or greater at rest.
“Treatment options for patients with heart failure have expanded considerably. There is more hope than ever before for patients with heart failure. These guideline recommendations will serve as a tool to guide the choice of therapy and in turn improve outcomes,” said Mariell Jessup, MD, FACC, FAHA, professor of medicine at the University of Pennsylvania School of Medicine and vice chair of the writing committee.
While a full update to the heart failure guideline is being developed, these recommendations are being released early to coincide with the release of the 2016 European Society of Cardiology Guideline on the Diagnosis and Treatment of Acute and Chronic Heart Failure. The recommendations are being released concurrently in order to minimize confusion and improve the care of patients with heart failure.
The 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure is publishing online today in the Journal of the American College of Cardiology, Circulation, and the Journal of Cardiac Failure.
About the Heart Failure Society of America
The Heart Failure Society of America (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. HFSA supports a multi-disciplinary clinical team approach for the preventions of and care for heart failure patients and is seeking to raise awareness about this devastating disease.
About the American College of Cardiology
The American College of Cardiology is a 52,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit acc.org.
About the American Heart Association
The American Heart Association is devoted to saving people from heart disease and stroke - America's No. 1 and No. 5 killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country. Follow us on Facebook and Twitter.