Final Thoughts on Heart Failure


The panel provides their final thoughts on the management of heart failure.

James Januzzi, MD: I’m going to bring this to a conclusion. But before I conclude, I’d like to get some final thoughts. I don’t want to put you on the spot, but I’m going to. Javed, why don’t we start with you? Any final thoughts you want to share about the overall picture for patients with heart failure?

Javed Butler, MD: Yes. Very quickly, medicine is a 2-front wall. Generating evidence is 1 but implementing is the other. If you don’t implement therapies, that doesn’t help. If you think about how cancer doctors think, “They say this is a lethal disease. I need to give these 3 medications.” It’s not that I’m going to give 1 and see if cancer goes down or up. This is a combination. Then, let’s watch for adverse effects and deal with it. In heart failure, we have a completely different mindset: give 1 medication, minor risk of adverse effects, some dizziness, or whatever. We don’t give those therapies. We need to change this mindset. Give combination therapy as soon as possible. All the issues related to costs that Dr Ibrahim and Jim mentioned are very true. Some really good points on how to deal with those issues were mentioned. But let’s get the science right. I practice in Mississippi, so it’s not the cost issue. I’m oblivious to that. Remember, in 2 years, 3 years, most of these drugs will go generic. At least buy into the concept of scientific evidence. What’s the best evidence for the therapy? When we can give it, give the best therapy. But if you get into the habit of that, this phase of cost issues will pass and most of these therapies will be generic in the future.

James Januzzi, MD: That’s great. Now, let’s go to Dr Ibrahim. Nasrien, your thoughts?

Nasrien E. Ibrahim, MD: Every patient with heart failure deserves the best treatment options we can offer. Also, we have to improve access to all patients regardless of their socioeconomic status. Every patient every time needs to be on the best therapies that we have available.

James Januzzi, MD: Succinct and perfectly stated. Gregg, Dr Fonarow, I’m going to let you take it home. Any final thoughts?

Gregg C. Fonarow, MD: Getting the patients on those right therapies are going to improve their clinical outcomes at the right time, with the right dose, and the remarkable benefits we’ve demonstrated compared with being on an ACE [angiotensin-converting-enzyme] inhibitor or a beta-blocker. To be on sacubitril valsartan, a beta-blocker, MRA [mineralocorticoid receptor antagonist], and an SGLT2 [sodium-glucose cotransporter – 2] inhibitor, you can extend median survival by over 6 years. We can give these patients back so much of the life that would be taken by their natural history of heart failure by using this combination of foundational therapy approach. That makes it so important in every setting, that we make sure we get the job done.

James Januzzi, MD: Thanks so much. Indeed, in the Massachusetts General Hospital Heart Center, we now have a GDMT [guideline-directed medical therapy] clinic, where our general cardiologists are learning about the benefits of the care that you’ve heard about today: improved quality of life, improved ejection fraction, and longer life span. Thus, it’s critically important that we get all hands-on deck and get our patients’ care optimized.

I want to thank you. Also, to our viewing audience, we hope you found this Practical Cardiology Viewpoints discussion to be rich and informative. I want to thank Drs Fonarow, Butler, and Ibrahim for joining me. I’m Jim Januzzi from the Mass General Heart Center. Thanks very much for joining us.

This transcript has been edited for clarity.

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