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Improvements made in HF management, but treatment access concerning
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The management of HF has made strides during the past few years, but accessing some of the necessary medications is still a major hurdle for many patients and their clinicians. Cardiology Today spoke with Seth J. Baum, MD, FASPC, chief medical officer of Excel Medical Clinical Trials, clinical affiliate professor of biomedical science at Florida Atlantic University in Boca Raton and president of the American Society for Preventive Cardiology about how to overcome hurdles and manage patients with HF safely and effectively.
Question: What are the current challenges of HF management?
Answer: One of the biggest challenges, sadly, with HF management is accessing some of the medications that we prescribe our patients. We’re having pushback from a lot of the payers. This is becoming a recurring theme in the practice of medicine in America. That’s the problem.
On the positive side of things, we are making some inroads into the management of HF, and there are some new drugs on the horizon that are being studied that are in phase 3 clinical trials; some other trials looking at reducing incident HF are in earlier phases. That’s very important.
Both HF with preserved ejection fraction and HF with reduced ejection fraction need our attention. Both are main sources of morbidity and mortality in the United States. We need to understand HF better and we really need to be on the cutting edge of managing HF.
Q: What are the current options for HF management?
A: We have the basic medications for HF management that include the ACE inhibitors or the angiotensin receptor blockers and the beta-blockers. Often these people could have atrial fibrillation and we need to control the rate of their AF. We also have to manage their symptoms, and we do that with diuretics and other agents. Then there are some of the newer agents that are available. Ivabradine (Corlanor, Amgen) is a new medication for HF that’s used in very specific populations. Sacubitril/valsartan (Entresto, Novartis) is a newer HF drug. Both of these drugs are very hard to access, with a lot of pushback from payers, but they’re effective agents in the right patient population. Cardiac resynchronization therapy with a biventricular device is another option.
Q: What may be available in the future for HF management?
A: One of the most interesting areas of current research is the use of sodium-glucose cotransporter 2 inhibitors to prevent HF. We have to remember this has not been approved at this point for the benefit of patients with HF, but it is being used for this indication in certain clinical trials right now. There is a lot of hope that it will become another agent to help manage or prevent HF.
Q: What are some key points that clinicians should keep in mind ?
A: HF is a devastating condition that although may feel like we haven’t made inroads, we have indeed made tremendous inroads with the development of new medications and devices. There’s a good deal of clinical research being done with new medications, and then there’s also a good deal of clinical research being done with the use of biological markers to help us manage congestive HF. This information will allow clinicians to incorporate the latest data into the management of patients with HF.
Q: What other research would you like to see done in this area?
A: I’d like to see research in the area of HFpEF. We have not made great strides in that arena because we don’t fully understand it. – by Darlene Dobkowski
Disclosure: Baum reports he participates in some clinical trials relevant to HF.