Constant research key to developing new heart failure treatments

Continuous research is key to developing new, effective treatments for heart failure (HF) or pumapalyang puso. One in five people aged over 40 will develop HF in their lifetime, and cases are on the rise. Despite improvement in survival rates with current therapies, patients with HF have poor prognosis. HF is the most common cause of hospitalization in people aged over 65. Half of all patients who were diagnosed with HF will most likely die within five years. Every year, HF costs the world economy $108 billion, with hospitalizations comprising 60 to 70 percent of direct treatment costs.

Although there are currently no conclusive local statistics on the prevalence of HF, the National Nutrition and Health Survey 2003 indicated that many Filipinos have risk factors for HF. These include smoking, obesity, hypertension, high cholesterol and diabetes. The last three risk factors are silent killers because initially, the symptoms are not discernible.

The Philippine Heart Association (PHA), through the PHA Council on Heart Failure chaired by Dr. Paul Ferdinand Reganit, is working on the PHA Heart Failure Registry Program. It aims to depict and dramatize the prevalence, demographics and clinical characteristics of HF in the country. We call on all public/private institutions to help complete the registry by sharing their patient databases. Target completion date is yearend 2016. Through this registry, doctors will be able to fully cater to their patients’ needs and provide individualized treatment.

A group of independent American cardiology experts is currently engaged in a continuous research. Its new analysis which was published in the journal Jama Cardiology online on June 22 showed timely and broad adoption of angiotensin receptor-neprilysin inhibitors (Arni) therapy each year among HF patients with reduced ejection fraction (HF-rEF) in the United States. Arni is a new type of treatment for HF; sacubitril/valsartan is the first-in-class Arni.

The analysis was based on an application of the results of the landmark Paradigm-HF Trial published HF statistics. It is the first study to quantify the possible impact of Arni therapy’s potential benefit in reducing death. The Paradigm-HF Trial showed that patients with HF-rEF who were given the Arni, sacubitril/valsartan, were more likely to be alive and less likely to have been hospitalized for sudden HF deterioration than those given the ACE-inhibitor enalapril. Paradigm-HF, the largest HF trial ever conducted so far, involved 8,442 patients including more than 200 Filipinos. Our very own Dr. Antonio Sibulo Jr. was the principal investigator of the Paradigm-HF Trial in the Philippines.

Approximately half of HF patients have a reduced ejection fraction or HF-rEF, a type of HF that has the worst prognosis. Ejection fraction is an important measurement in determining how well the heart is pumping out blood, and is also useful in diagnosing and monitoring HF. Although survival rates among patients with HF-rEF have improved in recent years, mortality remains high. In patients with HF-rEF, almost half (45 percent) of cardiovascular deaths and 36 percent of all-cause deaths are sudden.

Another important point raised in the analysis was the study authors’ opinion that delaying the routine use of Arni in clinical practice could result in the failure to prevent tens of thousands of deaths among patients with HF-rEF. The study authors stated that nearly 84 percent of HF-rEF patients in the United States —about 2.2 million people—are potential candidates for treatment with Arni.

Changes in evidence regarding current practice, outcomes and available interventions are all possible reasons to update clinical practice guidelines. It is worth noting that the Arni sacubitril/valsartan was recently given a Class 1 Recommendation—the strongest endorsement—in updated clinical practice guidelines released by the European Society of Cardiology, American College of Cardiology, American Heart Association, and Heart Failure Society of America.

Dr. Raul L. Lapitan is president of the Philippine Heart Association for 2016-2017. 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.