Therapeutic advances in heart failure

The 73rd ICS Annual Scientific Meeting and AGM also heard from Prof John McMurray, Professor of Medical Cardiology at the Institute of Cardiovascular and Medical Sciences, University of Glasgow, and Honorary Consultant Cardiologist at Queen Elizabeth University Hospital, Glasgow. Prof McMurray delivered the keynote speech for this year’s conference, titled ‘Heart failure: What’s new in 2022?’ 

He discussed the common causes of heart failure (HF) and provided a brief synopsis of some of the major trials on therapies such as SGLT2 inhibitors, as well as a preview of the upcoming release of data from the IRONMAN trial. He also discussed European and US guidelines and told the conference: “I think what hasn’t been recognised as much as it should be is that there were important changes in the ESC [European Society of Cardiology] guidelines, and these were much more clearly identified and worded in the US guidelines,” he said. 

“The first is about speed, and the recognition that we have been much too slow in the past to introduce these life-saving therapies that we have for patients with HF. If you think about cancer, it’s all about the urgency of diagnosis and treatment. Do we treat our patients with the same urgency? I think we don’t and the SGLT2 inhibitors really brought this home, because they reminded us that they are not unique in having that rapid onset of benefit. But it was so striking that it reminded us to ask, ‘what are we doing here, thinking about taking so long to start these treatments that save people’s lives?’” 

He pointed out that the guidelines have moved away from emphasising dose titration – “which is still important, to get people up to the target doses used in the trials” – but clearly state that early initiation of all treatments as quickly as possible is the goal. “The reason for that is that even low doses have substantial effects, perhaps not as much as the target doses in the trials, but they still all have substantial benefits. 

It has been a remarkable couple of years 

“Perhaps the most radical change in all of this that the traditional, historical, conventional order in which we prescribe treatments for patients with HFrEF [HF with reduced ejection fraction] is really no longer necessary; there should be no fixed sequence… or preference for any order of treatment,” he said. 

“It has been a remarkable couple of years,” Prof McMurray summarised. “We have two new treatments for HFrEF; we have seen the first ever recommendations in both transatlantic guidelines for HF with mildly reduced ejection fraction. Now, at long last, we have a treatment for HFpEF [HF with preserved ejection fraction] that is evidence-based, and robustly so,” he told the conference. “We have also seen more evidence for [efficacy of] intravenous iron, and we don’t want to forget about the very important changes in our thinking about the way we should be giving these treatments – and, of course, the biggest problem of all is implementation. 

“In most countries we look at, although we have fantastic treatments and we spend a huge amount of effort – patients volunteer to do trials, industry spends a lot of money funding these trials – often, unfortunately, our patients don’t get to benefit from those great treatments that we now have available.” 

Irish Cardiac Society, 73rd Annual Scientific Meeting and AGM, 6–8 October 2022.