treatment for heart failure

A large research study shows a significantly lower risk of death and improved quality of life when combining heart failure treatments.

It is estimated that only half of people diagnosed with heart failure live beyond five years. Heart failure is a chronic and life-limiting condition that gets worse over time.  Symptoms that severely affect quality of life include fainting, chest pain, water retention, and breathlessness. Heart failure progresses in stages; over time the heart muscle pumps less blood to vital organs and advancement through the stages of heart failure continues. Treatments are used to slow down or prevent the progression of heart failure. An important treatment for heart failure is neurohormonal blockade (NHB) drug therapy, which includes three different types of drugs: ACE inhibitors, beta-blockers, and mineralocorticoid antagonists. Once reaching final stage heart failure treatment options are limited and can include heart transplantation or implanting a mechanical heart pump known as a left ventricular assistive device (LVAD)

In a new study published in JAMA Cardiology researchers wanted to find out whether the use of NHB would also improve clinical outcomes in patients with LVADs. The researchers looked back at over 12,000 patients from the United States and Canada across an eight-year period. Patients all had an LVAD implanted and survived for at least six months after having it inserted. Researchers looked at survival rates, quality of life questionnaires, and six-minute walk test results of patients from over 170 different medical centres.

The researchers found that LVAD patients who received NHB therapy had significantly higher survival rates and quality of life compared to those who did not receive NHB therapy.

Interestingly, after having an LVAD inserted current guidelines do not automatically recommend the use of NHB therapy. This type of medication is only indicated when certain complications occur. This highlighted a surprising inconsistent use of NHB therapy among healthcare professionals. Medical centres were seen to use different combinations of medications for heart failure and treatment regimens were varied.

Although traditionally used to treat heart failure patients without a mechanical pump, NHB therapy is not always considered for final stage heart failure patients with an LVAD. This large study highlights an important positive improvement in quality of life and a lower risk of death when LVAD patients received NHB. In fact, patients receiving the medication at six months had a 56% survival rate at 4 years compared to a 43.9% survival rate of those who did not receive the medication. In addition, results in quality of life scores were improved. This is particularly significant as a small difference in score may show the difference between being independent with self-care or needing support from a carer.

The study did not assess how well patients tolerated NHB therapy, which may have been a factor in whether or not patients received NHB therapy. This could also suggest that some patients may have been generally healthier due to their ability to tolerate the medication, which should be considered for future research.

By understanding the combination of these treatments, a best-care regime may be produced in the future. End-stage heart failure is not reversible but with the right combination of treatments, this research study shows that patients can survive longer and have a more positive quality of life.

 

Written by Helen Massy, BSc.

 

References:

Benjamin, E., Virani, S., Callaway, C., Chamberlain, A., Chang, A., Cheng, S., Chiuve, S., Cushman, M., Delling, F., Deo, R., de Ferranti, S., Ferguson, J., Fornage, M., Gillespie, C., Isasi, C., Jiménez, M., Jordan, L., Judd, S., Lackland, D., Lichtman, J., Lisabeth, L., Liu, S., Longenecker, C., Lutsey, P., Mackey, J., Matchar, D., Matsushita, K., Mussolino, M., Nasir, K., O’Flaherty, M., Palaniappan, L., Pandey, A., Pandey, D., Reeves, M., Ritchey, M., Rodriguez, C., Roth, G., Rosamond, W., Sampson, U., Satou, G., Shah, S., Spartano, N., Tirschwell, D., Tsao, C., Voeks, J., Willey, J., Wilkins, J., Wu, J., Alger, H., Wong, S. and Muntner, P. (2018). Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation, 137(12).

McCullough, M., Caraballo, C., Ravindra, N., Miller, P., Mezzacappa, C., Levin, A., Gruen, J., Rodwin, B., Reinhardt, S., van Dijk, D., Ali, A., Ahmad, T. and Desai, N. (2019). Neurohormonal Blockade and Clinical Outcomes in Patients With Heart Failure Supported by Left Ventricular Assist Devices. JAMA Cardiology.

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