CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis.

Abstract

In this update, we focus on selected topics of high clinical relevance for health care providers who treat patients with heart failure (HF), on the basis of clinical trials published after 2017. Our objective was to review the evidence, and provide recommendations and practical tips regarding the management of candidates for the following HF therapies: (1) transcatheter mitral valve repair in HF with reduced ejection fraction; (2) a novel treatment for transthyretin amyloidosis or transthyretin cardiac amyloidosis; (3) angiotensin receptor-neprilysin inhibition in patients with HF and preserved ejection fraction (HFpEF); and (4) sodium glucose cotransport inhibitors for the prevention and treatment of HF in patients with and without type 2 diabetes. We emphasize the roles of optimal guideline-directed medical therapy and of multidisciplinary teams when considering transcatheter mitral valve repair, to ensure excellent evaluation and care of those patients. In the presence of suggestive clinical indices, health care providers should consider the possibility of cardiac amyloidosis and proceed with proper investigation. Tafamidis is the first agent shown in a prospective study to alter outcomes in patients with transthyretin cardiac amyloidosis. Patient subgroups with HFpEF might benefit from use of sacubitril/valsartan, however, further data are needed to clarify the effect of this therapy in patients with HFpEF. Sodium glucose cotransport inhibitors reduce the risk of incident HF, HF-related hospitalizations, and cardiovascular death in patients with type 2 diabetes and cardiovascular disease. A large clinical trial recently showed that dapagliflozin provides significant outcome benefits in well treated patients with HF with reduced ejection fraction (left ventricular ejection fraction ≤ 40%), with or without type 2 diabetes.

• Authors: Eileen O'Meara, Michael McDonald, Michael Chan, Anique Ducharme, Justin A Ezekowitz, Nadia Giannetti, Adam Grzeslo, George A Heckman, Jonathan G Howlett, Sheri L Koshman, Serge Lepage, Lisa M Mielniczuk, Gordon W Moe, Elizabeth Swiggum, Mustafa Toma, Sean A Virani, Shelley Zieroth, Sabe De, Sylvain Matteau, Marie-Claude Parent, Anita W Asgar, Gideon Cohen, Nowell Fine, Margot Davis, Subodh Verma, David Cherney, Howard Abrams, Abdul Al-Hesayen, Alain Cohen-Solal, Michel D'Astous, Diego H Delgado, Olivier Desplantie, Estrellita Estrella-Holder, Lee Green, Haissam Haddad, Karen Harkness, Adrian F Hernandez, Simon Kouz, Marie-Hélène LeBlanc, Douglas Lee, Frederick A Masoudi, Robert S McKelvie, Miroslaw Rajda, Heather J Ross, Bruce Sussex
• Journal: The Canadian journal of cardiology (Can J Cardiol) Vol. 36 Issue 2 Pg. 159-169 (02 2020) ISSN: 1916-7075 [Electronic] England
• PMID: 32036861 (Publication Type: Journal Article, Practice Guideline)
• Copyright: Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Angiotensin Receptor Antagonists
• Benzoxazoles
• Sodium-Glucose Transporter 2 Inhibitors
• tafamidis
• Neprilysin

Topics

• Amyloidosis (complications, drug therapy)
• Angiotensin Receptor Antagonists (therapeutic use)
• Benzoxazoles (therapeutic use)
• Heart Diseases (complications, drug therapy)
• Heart Failure (complications, drug therapy, physiopathology)
• Humans
• Mitral Valve Insufficiency (complications, physiopathology, surgery)
• Neprilysin (antagonists & inhibitors)
• Randomized Controlled Trials as Topic
• Severity of Illness Index
• Sodium-Glucose Transporter 2 Inhibitors (therapeutic use)
• Stroke Volume