TCA: How might these updated guidelines and/or new medications affect patients with heart failure with preserved ejection fraction?
Dr Tauras: These guideline changes are only relevant to patients with HFrEF, and they have nothing to do with patients with HFpEF. There is an ongoing randomized clinical trial (PARAGON HF) looking at valsartan/sacubitril in patients with HFpEF, however the results of this trial will not be available for several years. There is still no definitive evidence of any pharmacologic treatment conferring a mortality benefit in HFpEF.
TCA: The guidelines state that the respective organizations (ACC/AHA/ESC/HFSA) decided to “unify the message” by publishing their recommendations concurrently. Can you comment on the value of a multi-organizational approach to creating therapeutic guidelines?
Dr Tauras: I believe in this case such an approach is helpful. We haven’t had a new medication in heart failure guidelines in approximately 20 years, so the introduction of 2 new medications was bound to generate much controversy and confusion. Unifying the message from the major societies can help reduce this confusion.
This being said, guideline statements are always just that—guidelines. They are not set in stone, and can never be entirely individualized to a specific patient. For this, clinical judgment and knowledge of the primary data will always be critical.
Dr Patel: It’s really nice as a clinician, for 2 reasons. Number one, the consistency of the message makes the benefit of these agents very clear. And, number two, in the past, when there were discrepancies between the organizations, it made it difficult for us as clinicians to decide what to do.
This is a very exciting thing—to have 2 new available drugs after 20 years. Considering where we were before the advent of ACE inhibitors and ARBs, it’s remarkable to see that these 2 agents can incrementally benefit the patient. It’s great to keep pushing forward and improving.
We have started to use these drugs in our patients, but of course, with caution. Incrementally, we’ll be able to use these agents more uniformly. For right now, it’s too soon to tell what the benefits will be for our patient population.
- Antman EM, Bax J, Chazal RA, et al. Updated clinical practice guidelines on heart failure: an international alignment. J Am Coll Cardiol. 2016. doi:10.1016/j.jacc.2016.05.012.
- Yancy CW, Jessup M, Bozkurt B, et al; on behalf of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2016. doi:10.1016/j.jacc.2016.05.011.