The latest advances in heart failure treatment

Heart failure is a chronic condition that occurs when the heart is unable to pump blood efficiently, causing symptoms such as fatigue, shortness of breath, and fluid retention. Recent advances in the field of cardiology have seen notable breakthroughs in the treatment of heart failure, leading to improved outcomes and enhanced quality of life.

Dr Naveen Mudalagiri, highly experienced consultant cardiologist, explores the latest developments in heart failure treatment, the role of biomarkers, new surgical options, and the criteria used to determine the most effective therapy.

What are the most significant advances in heart failure treatment?

Recent years have witnessed remarkable progress in pharmacological treatments for heart failure. Two classes of medications, in particular, have emerged as transformative: SGLT2 inhibitors and ARNI (angiotensin receptor-neprilysin inhibitors).

SGLT2 inhibitors, originally developed for diabetes management, have demonstrated profound benefits in heart failure patients. These medications not only help lower blood sugar levels but also promote diuresis (increased urination), which alleviates reduced fluid retention. Studies have shown that SGLT2 inhibitors can significantly lower the risk of heart failure hospitalisations and improve overall cardiovascular outcomes.

ARNI represents another breakthrough in heart failure treatment. This dual-action medication, which combines an angiotensin receptor blocker with neprilysin inhibition, enhances the body’s natural vasodilatory peptides while simultaneously inhibiting the harmful effects of angiotensin II. Studies have shown that this leads to improved cardiac function and has been shown to reduce hospitalisations and mortality rates in patients with heart failure.

Moreover, newer therapies like omecamtiv mecarbil, which is a cardiac myosin activator, are currently under research and show promise for the future management of heart failure. This medication works by improving cardiac contractility, which may offer additional therapeutic options.

What is the role of biomarkers in the management of heart failure?

Biomarkers play a critical role in the diagnosis, management, and prognosis of heart failure. They are biological indicators in the blood that can provide valuable information about the severity of the condition and guide treatment decisions. The most commonly-used biomarkers in heart failure are B-type natriuretic peptide (BNP) and its inactive form, N-terminal pro-BNP (NT-proBNP).

When the heart is under stress (such as in heart failure), it releases BNP and NT-proBNP in response to the increased pressure and volume overload. Elevated levels of these biomarkers in the blood are thus indicative of heart failure and can help differentiate between heart failure and other conditions with similar symptoms, such as pulmonary disease.

Additionally, monitoring BNP and NT-proBNP levels over time can help cardiologists assess the effectiveness of treatment and detect any worsening heart function. Regular testing then allows for timely adjustments to medications and interventions, which can significantly improve patient outcomes.

Furthermore, research into new biomarkers, such as galectin-3 and ST2, is ongoing. These markers may provide additional insights into the prognosis of heart failure and help identify patients at higher risk for adverse events.

Are there any new surgical options for heart failure?

In addition to pharmacological advancements, new surgical options have emerged to improve outcomes for patients with heart failure. Two surgical options are notable: heart transplant and left ventricular assist devices (LVADs).

Heart transplant remains the gold standard for eligible patients with end-stage heart failure that involves replacing a failing heart with a healthy donor heart. However, limited donor organ availability has led to the development of alternative surgical options, including left ventricular assist devices (LVADs).

LVADs are mechanical devices that help the heart pump blood, providing support for patients awaiting a heart transplant or those who aren’t candidates for surgery. The latest LVAD models are smaller and more durable, improving patient mobility and overall quality of life.

Other surgical options include valve repair or replacement for patients with heart failure due to valvular heart disease. Advances in minimally invasive techniques have made these procedures safer and more effective, allowing for quicker recovery times and improved outcomes.

What criteria is used to determine the most effective treatment for each patient?

Determining the most effective treatment for each patient involves a comprehensive assessment of their individual needs and circumstances. Several criteria are considered in this decision-making process, including the type and severity of heart failure, underlying causes, comorbid conditions, and patient preferences.

Heart failure is categorised into different types, mainly heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). The treatment approach may differ based on the classification, as the underlying mechanisms and responses to therapy can vary significantly.

Cardiologists conduct thorough evaluations, including physical examinations, laboratory tests, and imaging studies, to evaluate the patient's condition fully. These assessments help identify potential contributing factors which may influence treatment decisions. In addition, patient preferences and lifestyle considerations are essential to ensure that the chosen treatment aligns with their needs and enhances their quality of life.

If you would like to book an appointment with Dr Naveen Mudalagiri, head on over to his Top Doctors profile today.