New Drug Combinations Could Cut Heart Failure Deaths by 60%
New Drug Combinations Could Cut Heart Failure Deaths by 60%
Source: Medscape.
Date: May 15, 2025
Event: 91st German Society of Cardi0vascular medicine annular conference.
Key Points:
1. Early and Optimized Treatment Saves Lives
• Starting drug therapy immediately after diagnosis improves outcomes.
• Mortality in heart failure with reduced or mildly reduced ejection fraction (HFrEF or HFmrEF) can drop by up to 60% with optimized drug combinations.
2. Recommended Quadruple Drug Combo (ESC Guidelines 2021):
• ACE inhibitor or ARNI (sacubitril/valsartan)
• Beta-blocker
• Mineralocorticoid receptor antagonist (MRA)
• SGLT2 inhibitor (e.g. dapagliflozin)
3. Loop diuretics are added for fluid overload.
Fast Diagnosis is Critical
• Many patients face delays in diagnosis, which leads to worse outcomes.
• In Sweden’s REVOLUTION-HF study, only 29% of patients with high natriuretic peptides were diagnosed within a year.
Recommended Drug Initiation Sequence:
1. Start SGLT2 inhibitor → check tolerance
2. Add MRA alongside
3. Titrate beta-blocker over 4 weeks
4. Start and adjust ARNI over 5 weeks (once blood pressure is stable)
Life Expectancy Gains from Quadruple Therapy:
• 55-year-old patients may gain 6.3 years of life compared to older dual therapy.
• Even 80-year-old patients may gain 1.4 years of life.
Beyond Medications – Devices and Monitoring Matter Too:
• Consider ICDs, CRT devices, and pacemakers for advanced HF.
• Telemonitoring is underused but can save lives.
• Managing arrhythmias (like atrial fibrillation) also improves survival.
New Medications and Innovations:
• Vericiguat: A new oral drug for patients worsening despite optimal therapy. Can be used even with low kidney function (eGFR ≥15).
• Finerenone: A nonsteroidal MRA shown to reduce HF hospitalizations, especially in patients with diabetic kidney disease.
Iron Deficiency in HF:
• IV iron (ferric carboxymaltose) improves symptoms and exercise tolerance.
• Meta-analysis of 6 trials shows 28% reduction in HF hospitalizations + CV death.