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Feature Article

What’s on the horizon for heart failure management?

Peter MacDonald, SCOTT MCKENZIE

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COPYRIGHT © 2019 MEDTRONIC ALL RIGHTS RESERVED. REPRINTED WITH PERMISSION
COPYRIGHT © 2019 MEDTRONIC ALL RIGHTS RESERVED. REPRINTED WITH PERMISSION

Abstract

Despite major advances in the treatment of heart failure over the past three decades, the prognosis for most patients remains guarded, particularly for those with acute decompensated heart failure. Telemedicine and remote monitoring are likely to play an increasingly important role in supporting GPs to manage patients, especially those in rural and remote communities. Several emerging drugs and devices show considerable promise in further improving the outlook for these patients.

Key Points

  • Advances in remote monitoring of patients with chronic heart failure (HF), including implantable pulmonary arterial pressure monitors, allow GPs to detect and intervene to prevent clinical worsening, reducing the need for rehospitalisation.
  • Sodium–glucose co-transporter-2 (SGLT2) inhibitors improve survival and reduce hospitalisation in patients with HF with reduced ejection fraction, with or without diabetes.
  • HF with preserved ejection fraction (HFpEF) remains an area of unmet need, with no drug yet shown to improve survival; trials of novel agents, including SGLT2 inhibitors, are underway.
  • Several promising drugs are under investigation for treating transthyretin cardiac amyloidosis, which likely accounts for 10 to 15% of patients with HFpEF.
  • There are various devices under investigation that can be implanted using minimally invasive techniques to treat certain subgroups of patients, such as the mitral clip for patients with severe functional mitral regurgitation and interatrial septal devices for those with HFpEF.
  • Mobile extracorporeal membrane oxygenation retrieval teams allow critically ill patients with HF to be retrieved from rural and remote sites.

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COPYRIGHT © 2019 MEDTRONIC ALL RIGHTS RESERVED. REPRINTED WITH PERMISSION
COPYRIGHT © 2019 MEDTRONIC ALL RIGHTS RESERVED. REPRINTED WITH PERMISSION