Filling the gaps in guideline-directed care

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Heart failure rehospitalizations and care for patients with heart failure with reduced ejection fraction (HFrEF) are primary concerns for clinicians.
• Heart failure with preserved ejection fraction (HFpEF) is an emerging population requiring dedicated attention, despite shared characteristics with HFrEF.
• Treatment options for HFpEF are historically more limited compared to HFrEF.

Purpose of the Study:

• To highlight the growing need for attention to HFpEF management.
• To discuss current and emerging pharmacologic treatments for heart failure.
• To emphasize the importance of multidisciplinary teams and updated guidelines in heart failure care.

Main Methods:

• Review of current FDA-approved and investigational therapies for heart failure.
• Discussion of guideline-directed medical treatment principles.
• Emphasis on collaborative, team-based care approaches.

Main Results:

• Expanded FDA indications for sacubitril/valsartan to include selected HFpEF patients.
• Sodium-glucose cotransporter-2 (SGLT2) inhibitors approved for symptomatic HFrEF to reduce hospitalizations and cardiovascular death.
• Approval of vericiguat, an oral soluble guanylyl cyclase activator.
• Ongoing investigation of omecamtiv mecarbil and nonsteroidal aldosterone antagonists.

Conclusions:

• Guideline-directed medical treatment benefits all heart failure patients.
• Recent pharmacologic advancements offer new therapeutic avenues for HFrEF and HFpEF.
• Effective heart failure management necessitates interdisciplinary teams, innovative strategies, and adherence to updated clinical guidelines, such as the ACC 2021 update.