Heart failure chips away at quality of life slowly overtime. What may begin as fatigue or less of an appetite, becomes something more that makes it difficult to enjoy staying active with family and friends. Difficulty breathing when sleeping and waking exhausted or even a persistent cough begin to consume each day and night. Not only is it becoming more difficult to walk out to the car, it's uncomfortable - as swelling in the legs and feet make socks and shoes feel tight. It is a condition more than 6 million Americans are living with today and one of the top reasons people over the age of 65 end up going to the hospital. Beginning stages of heart failure can be treated with medication and lifestyle changes. However, as the heart continues to weaken and heart failure advances, more aggressive treatment is required. Oklahoma Heart Institute cardiologist and congestive heart failure expert, Dr. Sandra Rodriguez, weighs in on a new drug researchers say is showing positive outcomes for patients.
“Paradigm-HF is a recent heart failure trial for patients with symptomatic heart failure with ejection fraction less than 35 percent,” she says. “The study compared an already known medication, Enalapril, with LCZ696, which is a compound of Neprilysin inhibitor and a valsartan-like drug. The study ran for 27 months. Researchers found this new drug achieved a 3 percent absolute reduction in cardiovascular death and heart failure hospitalization or 20 percent relative reduction. To prevent one event, you would need to treat 21 patients.”
While this is good news for the treatment and management of heart failure, Dr. Rodriguez cautions health care providers and patients that the study was not without points which need further clarification. “The decrease in mortality is important, but there are some pitfalls to the findings, which only time will be able to better clarify,” she explains. “For example, only about 50 percent of the patients were on mineralocorticoid antagonists, only 15 percent had defibrillators placed and only 7 percent had cardiac resynchronization therapy in place. Also, only 7.4 percent of the patients were from North America, and thus genetic implications of and response to medications can be a factor to consider.”
LCZ696 is making headlines, however, as it is one of the first drugs since the class of drugs, known as ACE inhibitors, showed real improvements in the treatment of heart failure in the 1980s.
“In general it is very exciting, as with any medication that promises an increase in survival, but most of our aim should be directed to the prevention for patients with treatable direct and indirect risk factors such as hypertension, coronary artery disease, diabetes, smoking, sedentary lifestyle. We need to remember heart disease is a disease that causes as many deaths as cancer in our society,” shares Dr. Rodriguez.