Management updates in heart failure with mildly reduced or preserved ejection fraction

Area of Science:

• Cardiology
• Public Health
• Pharmacology

Background:

• Heart failure (HF) is a growing public health issue in the US, impacting 6.7 million adults.
• High hospitalization and mortality rates persist despite guideline-directed medical therapy (GDMT).
• Limited therapeutic options exist for HF with preserved ejection fraction (HFpEF) and HF with mildly reduced ejection fraction (HFmrEF), indicating a significant unmet clinical need.

Purpose of the Study:

• To review the pathophysiology, epidemiology, and staging of HF, focusing on HFmrEF and HFpEF.
• To summarize current GDMT, including SGLT2 inhibitors and mineralocorticoid receptor antagonists (MRAs).
• To evaluate the safety and efficacy of finerenone, a nonsteroidal MRA, as an adjunct therapy for HFmrEF and HFpEF.

Main Methods:

• Review of current literature on HF pathophysiology, epidemiology, and GDMT.
• Analysis of clinical trial data regarding finerenone's safety and efficacy in HFmrEF and HFpEF patients.
• Examination of barriers to optimal care and economic burden associated with HF phenotypes.

Main Results:

• Finerenone, a nonsteroidal MRA, demonstrates safety and efficacy as an adjunct therapy for HFmrEF and HFpEF.
• SGLT2 inhibitors and MRAs are evolving components of GDMT.
• Diagnostic nomenclature, coding, and access challenges contribute to the economic burden of HF.

Conclusions:

• Managed care strategies are needed to facilitate therapy initiation and access to emerging treatments like finerenone.
• Improving outcomes for HFmrEF and HFpEF requires addressing persistent barriers to optimal care.
• Optimizing treatment and access for HF patients can improve outcomes and manage healthcare resource utilization.