Dear Members,
In this newsletter we would like to focus on optimizing individual heart failure treatment.
A mineralocorticoid receptor antagonist (MRA) is recommended in patients with chronic heart failure.1–5 However, the effects of the early initiation of an MRA in patients with acute heart failure (AHF) is less documented. Kitakaze and co-workers from Japan have performed a multicentre, randomized, double-blind, placebo-controlled, parallel-group study in 300 patients with AHF, randomized to eplerenone or placebo. The authors concluded that early initiation of eplerenone in patients with AHF could safely be utilized.
The PARADIGM-HF study6 did not analyse the effect of ventricular remodelling on patients with different aetiologies, which may affect clinical treatment outcomes. In a paper from Taiwan, Chang and co-workers aimed to compare left ventricular ejection fraction (LVEF) following sacubitril/valsartan (SAC/VAL) treatment and its association with clinical outcomes in 1576 patients. The authors found that patients with non-ischaemic cardiomyopathy (NICM) had a higher degree of LVEF improvement than those with ischaemic cardiomyopathy (ICM) following SAC/VAL treatment, and significant improvement of LVEF in NICM patients.
Anticancer drugs may be associated with different kinds of heart problems.7–9 The anti-HER2 agent trastuzumab reduces risk of disease progression or death in breast cancer patients.9 However, HER2 isoforms are also expressed in cardiomyocytes and may cause increased risk of left ventricular (LV) dysfunction and a five- to seven-fold increased risk of heart failure.9 Paterson and co-workers aimed to characterize the cardiac and cardiometabolic phenotype of trastuzumab-mediated toxicity and potential interactions with cardiac pharmacotherapy. The authors report that trastuzumab results in impaired cardiac function and early myocardial inflammation.
The beneficial effect of β-blocker on heart failure with reduced ejection fraction (HFrEF) is well established.1,10 However, its effect on the short-term outcome of heart failure with midrange ejection fraction (HFmrEF) is less clear. From the The Patient-centred Evaluative Assessment of Cardiac Events Prospective Heart Failure (China, PEACE 5p-HF) study Zheng et al. concluded that in patients with HFmrEF, β-blocker use was associated with lower risk of all-cause death, but not with lower risk of all-cause hospitalization.
Uncontrolled blood pressure (BP) increases the risk of developing HF.1 The effect of spironolactone on the BP of patients at risk of developing HF is yet to be determined. Ferreira and co-workers aimed to evaluate the effect of spironolactone on the BP of patients at risk for HF and whether renin can predict spironolactone’s effect in a prospective multicentre randomized open-label blinded endpoint (PROBE) trial. The conclusion of the study was that spironolactone should be considered for lowering blood pressure in patients who are at risk of developing HF.
The pandemic caused by the SARS-CoV-2 virus has spread worldwide and many questions about the pathophysiology of the SARS-CoV-2 infection are unanswered. In a study from Spain, Masana and co-workers aimed at assessing the effect of statin therapy at hospital admission for COVID-19 on inhospital mortality. In a retrospective observational study, they report a significantly lower mortality rate in patients on statin therapy than the matched non-statin group and the mortality rate was even lower in patients who maintained their statin treatments during hospitalization compared with the non-statin group. Also, the Cox model suggested that statins were associated with reduced COVID-19-related mortality. The authors concluded that a lower SARS-CoV-2 infection-related mortality was observed in patients treated with statin therapy prior to hospitalization. Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19. Several other observational studies have shown potential beneficial effects of lipid-lowering treatment on the course of COVID-19 with significantly improved prognosis and reduced mortality.11–13 Findings from ongoing rigorously conducted and adequately powered randomized clinical trials (RCTs) can assess the possible efficacy of lipid-modulating agents in the prevention or treatment of various stages of COVID-19 and may open new horizons for research and clinical practice.14
Use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEis/ARBs) is thought to affect COVID-19 through modulating levels of angiotensin-converting enzyme 2, the cell entry receptor for SARS-CoV2.15,16 There are many observational studies on this topic.17,18 In a meta-analysis, McMurray and co-workers included non-randomized observational COViD-19 studies, comparing ACE inhibitor/ARB treatment. In patients with hypertension, ACE inhibitor or ARB treatment was not associated with a greater likelihood of SARS-CoV-2 infection. The authors concluded that ACE inhibitors and ARBs appear safe in the context of SARS-CoV-2 infection and should not be discontinued.
Heart failure patients are usually at high risk of polypharmacy and, consequently, potentially inappropriate prescribing leading to poor clinical outcomes.21–23 We are pleased to publish a position statement from Coats and co-workers entitled ‘Position statement on HFrEF specific inappropriate prescribing’.
In relation to our educational courses, detailed information regarding programmes are found on our webpage.
During 2022 we will also launch several educational and interactive webinars, on which further information will follow in coming newsletters and online.
The Pharmacotherapy in Older People (POP) course will also be held 20-21 October 2022 – onsite in Madrid. It is an engaging and interactive course to improve the professional knowledge and skills on cardiovascular pharmacotherapy in older patients. This is a great opportunity to improve the knowledge pharmacotherapy in older people for general physicians, care of the elderly professionals, nurses, cardiologists, nephrologists, diabetologists, trainees and healthcare professionals dealing with elderly patients in their daily clinical practice.
The All About Clinical Trials (AACT) course will be run 8-9 December 2022 - onsite in Stockholm, in collaboration with the Karolinska Institutet and the Swedish Cardiac Society. This event will provide a deep insight into the long journey which brings pharmacological compounds from bench to bedside, i.e. from trial design for testing new drugs (generation of evidence and its critical appraisal) to implementation of pharmacological treatments for daily use in science and patient care. This course is essential for clinical cardiologists, clinical pharmacologists and healthcare professionals in general with an interest in translational and clinical research methodologies. Students and trainees will also have an opportunity to acquire or improve knowledge and clinical skills in clinical trial design, management and data interpretation.
We are launched a new educational programme: Cardiovascular Pharmacotherapy in women this year, and the next course will be held onsite in London 24-25 February 2023. The course will address unmet needs and knowledge gaps in the management of cardiovascular disease in women and aims at providing a balanced and practical view on the topic. Particular emphasis will be put on gender specific risk factors, dosing, evidence-based treatments and prevention of disease. The target audience will be health care personnel’s responsible for the care of women with CV conditions, as well as trainees aiming to enter these fields.
EuroCVP: After a long period during which scientific conferences have been impacted by the coronavirus pandemic, we look forward to welcoming you in-person, in the city of Florence, Italy, for the 2022 EuroCVP conference. We are excited to organize the upcoming EuroCVP 2022 with a condensed programme of intensive learning with all updates in the field of cardiovascular pharmacotherapy and networking opportunities with key opinion leaders of the field. An attractive scientific programme with excellent speakers and young researchers in a dynamic and interactive format will provide a superb opportunity for broad exchange of knowledge. The scientific programme is organized in 16 sessions – each addressing evolving fields in cardiovascular pharmacotherapy that will be enriched by profound discussions, expert panels and joint-sessions with other ESC associations and working groups. The EuroCVP 2022 will provide unique opportunities for networking, debate and interaction with world-leading experts. We look forward to welcoming you to Florence for a fantastic EuroCVP 2022!
Cardiovascular Pharmacotherapists and Trialists of Tomorrow (CPTT) is the Young community of the ESC Working Group on Cardiovascular Pharmacotherapy, dedicated to young professionals under 40 years (physicians, nurses, scientists or others) with a special interest in cardiovascular pharmacotherapy and clinical trials. The benefits of joining the CPTT are many and we encourage you to join, it is free of charge. You need to be a member of the WG Cardiovascular Pharmacotherapy, which can be done on this webpage.
On behalf of the Working Group nucleus,
Alexander Niessner, Chairperson 2020-2022 and
Anne Grete Semb, Communication Coordinator 2020-2022
Our mission: To reduce the burden of cardiovascular disease.