The American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Failure Society of America have updated their heart failure guidelines to include an angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan [Entresto]), and a sinoatrial node modulator (ivabradine [Corlanor]) to the list of treatment options. 

Previously recommended drug options for these patients include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), aldosterone antagonists, beta blockers, the combination of isosorbide dinitrate and hydralazine and diuretics.  The new recommendation for patients with chronic symptomatic heart failure with reduced ejection fraction consists of an ACE inhibitor or ARB or ARNI, along with a beta blocker and an adolsterone antagonist.

The treatment additions reflect a move to greater individualized care. Chair of the writing committee, Clyde W. Yancy, MD, MSc, MACC, FAHA, FHFSA, said “Not every patient is a good candidate for every drug; these guidelines can help physicians decide who best fits which treatment.” 

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While a fully updated guideline is in development, these updates to the 2013 ACCF/AHA Guideline for the Management of Heart Failure are being released early to coincide with the release of a new European Society of Cardiology Guideline, in an effort to minimize any confusion.

Last week Novartis announced 40 active and planned clinical studies to generate further data on Entresto, currently indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic HFrEF. Depending on results, it is likely that the trial results will be used in further new indication drug applications.

The trials will enroll patients from over 50 countries and participation is designed for over 5 years. The trials will fall under an umbrella of trials Novartis is calling ‘FortiHFy’ (Fortifying Heart Failure clinical evidence and patient qualitY of life). Some of the trials include, PARAGON-HF2, PARADISE-MI1, TRANSITION-HF3 and PIONEER-HF4.

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