Discussion on Heart Failure: updates from ESC Congress 2023
Oct 6, 2023
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Experts discuss guidelines for managing patients with worsening heart failure including early follow-up, monitoring lab tests, and congestion state. Challenges of managing heart failure patients outside the hospital, role of general cardiologists in managing heart failure, importance of iron and diagnosis of iron deficiency, advancements in heart failure treatment with ARNI and SGL2 inhibitors.
Early follow-up after discharge is crucial in improving outcomes for heart failure patients.
Iron supplementation, specifically ferric carboxymaltose, can improve quality of life and reduce hospitalizations in heart failure patients.
Deep dives
Management of Heart Failure: Key Recommendations
During the podcast, two important consensus papers were discussed, providing guidelines for the management of heart failure. The first paper emphasized the importance of early follow-up after discharge to improve outcomes. It recommended that patients be followed up one or two weeks after discharge in order to monitor their progress and intervene if needed. The second paper focused on the post-discharge management of patients hospitalized for acute heart failure. It emphasized the monitoring of laboratory tests, such as serum creatinine and potassium, as well as the assessment of congestion state. The paper also highlighted the importance of checking medication adherence and considering medication up-titration when appropriate.
Iron Supplementation and Heart Failure
The podcast also touched upon the topic of iron supplementation in heart failure patients. Iron deficiency is common in heart failure and is associated with poor exercise capacity, quality of life, and increased morbidity and mortality. Several studies have shown that intravenous iron supplementation, specifically ferric carboxymaltose, can improve patients' quality of life and reduce the risk of cardiovascular and heart failure hospitalizations. While the effect on mortality is still uncertain, the podcast emphasized the importance of proactive screening for iron deficiency in heart failure patients and considering ferric carboxymaltose treatment if diagnosed.
Novel Therapies for Heart Failure
The podcast highlighted two promising novel therapies for heart failure: ARNI (angiotensin receptor-neprilysin inhibitor) and SGLT2 inhibitors. ARNI has shown positive results in heart failure patients with reduced ejection fraction and is recommended as a replacement for ACE inhibitors or angiotensin receptor blockers. The podcast encouraged cardiologists to consider ARNI therapy, starting with a low dose and gradually titrating it up. SGLT2 inhibitors, originally developed for diabetes, have shown breakthrough benefits in heart failure treatment, especially in heart failure with preserved ejection fraction. They have demonstrated symptomatic improvement, reduction in hospitalizations, and improved overall outcomes in heart failure patients. Both ARNI and SGLT2 inhibitors were described as valuable additions to the treatment options available for heart failure patients.
With Riccardo Asteggiano, University of Insurbria, Varese - Italy, Ruxandra Christodorescu, University of Medicine and Pharmacy Victor Babes, Timisoara - Romania & Piotr Ponikowski, Wroclaw Medical University, Wroclaw - Poland.
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