‘Mild, stable’ heart failure is a myth

Heart Failure (HF) or pumapalyang puso should not be underestimated. It is a health menace that should not be downplayed.

Mild symptoms in HF do not equate with mild disease. There is no such thing as mild HF in the same manner that there is no such thing as “mild” cancer.

HF is a progressive disease. Take note. What we may think of as a stable patient is in fact, silently becoming more serious.

This was the key message of renowned British cardiologist Prof. John McMurray during a recent scientific meeting organized by research-based Swiss health-care company Novartis in Quezon City that was attended by local cardiologists, internists and other medical specialists.

As observed by Prof.

McMurray, the principal investigator of the Paradigm-HF study, there is a common  misconception that therapeutic success is achieved when patients with HF are clinically stable or have mild symptoms. The reality is patients with mild symptoms are not stable, but tend to get worse rapidly, even when they are on optimal treatment.

HF is a critical condition in which the heart weakens, therefore, cannot pump sufficient blood to complete the oxygen needs of the body. After a while, if not treated well, it will lead to severe fatigue; breathlessness; damage to the heart, kidneys and liver; and ultimately death.

One precipitation factor of HF is coronary artery disease. A form of which is atherosclerosis—the narrowing and later on clogging of the arteries due to fatty deposits (plaques) accumulated through time. Other precipitation factors are obstruction of blood supply to the heart muscle and unmanaged high-blood pressure (hypertension).

Prof. McMurray pointed out that one in four patients with mild symptoms die or are hospitalized within three years. On the other hand, over 11 percent of patients per year in the enalapril group in the Paradigm-HF study exhibited some manifestations of worsening, and an even higher proportion experienced deterioration in quality of life. More alarmingly, according to Prof. McMurray, other studies have shown that in about one in four patients the first manifestation of heart failure progression or worsening was sudden death.

The Paradigm-HF study demonstrated that patients with heart failure with reduced ejection fraction who were given sacubitril/valsartan were more likely to be alive and less likely to have been hospitalized for sudden deterioration of their heart failure than those given the current standard of treatment, the ACE-inhibitor enalapril.

The British heart doctor further stressed that mild, clinically stable heart failure is a myth. There is an urgent need to enhance the existing  HF  management strategies. “The Paradigm-HF trial has demonstrated that sacubitril/valsartan will be an indispensable core for enhanced HF therapy,” he added.

Sacubitril/valsartan is the first and only treatment to show a significant mortality benefit (reducing HF deaths) in a head-to-head trial against the current gold standard, enalapril. The landmark Paradigm-HF study showed that sacubitril/valsartan reduced the risk of death from cardiovascular causes by 20 percent, reduced heart failure hospitalizations by 21 percent, and reduced the risk of all-cause mortality (all deaths that occurred in patients in the study, regardless of the cause) by 16 percent. Overall, sacubitril/valsartan resulted in a 20-percent risk reduction in cardiovascular death or HF hospitalization.

Developed by Novartis, sacubitril/valsartan is a twice-daily oral pill that provides a novel strategy for treating HF. It amplifies the natural defense response of the heart, while simultaneously suppressing the harmful effects of the body’s hormone system, ultimately leading to reduced strain on the cardiovascular system.

Meanwhile, on May 24-27, the Philippine Heart Association (PHA) will hold its 47th Annual Convention and Scientific Meeting, for us cardiologists to stay updated and be challenged with innovations and cardiovascular management in its diversity.

The management of cardiovascular disease remains a continuing snag despite an abundance of evidence and guidelines born out of landmark studies, research and development, advance technology and availability of precise and targeted pharmacologic treatment. The challenge to us cardiologists is how to tailor our strategies to specific subpopulations where “run-of-the-mill” approach in managing cardiac patients may not be applicable. Hence, the  PHA convention theme is “Optimizing Cardiovascular Care in Diverse Population.”

Dr. Alex T. Junia is the president of the Philippine Heart Association 2015-2016. The PHA is an organization of cardiovascular specialists and lay members that ensure accessible, affordable and quality cardiovascular education and care for everyone. For more information, visit www.philheart.org.