Heart Failure Guidelines: Question #16 With Dr. Harriette Van Spall
Episode #289 in the CardioNerds Decipher the Guidelines Series refers to Sections 11.3 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure and discusses the case of a 33-year-old woman from Haiti, who is seeking family planning advice for a second child. Her previous pregnancy had complications due to preeclampsia and peripartum cardiomyopathy with an LVEF of 35%. The question – What is the medical recommendation for optimizing the woman’s health before her second pregnancy? – asked by Western Michigan University medical student and CardioNerds intern Shivani Reddy, is answered first by Johns Hopkins Osler internal medicine resident and CardioNerds Academy Fellow Dr. Justin Brilliant. Then, by expert faculty Dr. Harriette Van Spall, Associate Professor of Medicine, cardiologist, and Director of E-Health at McMaster University.
Heart Failure Guidelines: Question #17 With Dr. Biykem Bozkurt
In episode #291 in the CardioNerds Decipher the Guidelines Series, Keck School of Medicine USC medical student and CardioNerds intern Hirsh Elhence asks a question regarding the case of a 63-year-old male with a history of coronary artery disease, type 2 diabetes mellitus, hypertension, obesity, and tobacco use disorder who presents for a routine check-up. Referring to Section 5.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure, the question inquiring of the best addition to optimize the male’s medical therapy is answered first by Greater Baltimore Medical Center medicine resident and Johns Hopkins MPH student and CardioNerds Academy House Chief Dr. Alaa Diab. Then, by expert faculty Dr. Biykem Bozkurt, the Mary and Gordon Cain Chair, Professor of Medicine, Director of the Winters Center for Heart Failure Research, and an advanced heart failure and transplant cardiologist at Baylor College of Medicine in Houston.
Heart Failure Guidelines: Question #18 With Dr. Shelley Zieroth
Episode #295 in the CardioNerds Decipher the Guidelines Series discusses the case of a 48-year-old woman with signs and symptoms of heart failure, particularly jugular venous distention, bibasilar crackles, an S3 heart sound, and reduced left ventricular ejection fraction on echocardiography. The main question refers to Sections 3.2, 4.1, 4.3, and 4.4 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure and is asked by Texas Tech University medical student and CardioNerds Academy intern Dr. Adriana Mares. The question concerning which diagnostic test has a Class I indication for further evaluation is answered first by Baylor University cardiology fellow and CardioNerds FIT trialist Dr. Shiva Patlolla, and then by expert faculty Dr. Shelley Zieroth, an advanced heart failure and transplant cardiologist, head of the Medical Heart Failure Program, and an associate professor in the section of cardiology at the University of Manitoba.
Heart Failure Guidelines: Question #19 With Dr. Clyde Yancy
Episode #298 in the CardioNerds Decipher the Guidelines Series presents the case of a 36-year-old woman, 6 months postpartum, diagnosed with peripartum cardiomyopathy during her pregnancy. At her follow-up visit, she reports no leg edema but feels breathless when carrying her child upstairs. She struggles with sleep but doesn’t experience orthopnea. The main question regarding the next best steps in her treatment is asked by New York Medical College medical student and CardioNerds intern Akiva Rosenzveig. It is answered first by Lahey Hospital and Medical Center internal medicine resident and CardioNerds Academy House faculty leader Dr. Ahmed Ghoneem, and then by expert faculty Dr. Clyde Yancy, professor of medicine and medical social sciences, chief of cardiology, and vice dean for diversity and inclusion at Northwestern University.
Heart Failure Guidelines: Question #20 With Dr. Robert Mentz
In episode #301 in the CardioNerds Decipher the Guidelines Series, a 60-year-old woman with a history of alcohol-related dilated cardiomyopathy presents for follow-up. She has just reached her five-year sobriety milestone and is asymptomatic at rest and up to moderate exercise. The main question is asked by Palisades Medical Center medicine resident and CardioNerds intern Dr. Maryam Barkhordarian based on the most appropriate response to the patient’s request to discontinue her metoprolol medication. The question is answered first by Hopkins Bayview medicine resident Dr. Ty Sweeny, and then by expert faculty Dr. Robert Mentz, associate professor of medicine and section chief for heart failure at Duke University and editor-in-chief of the Journal of Cardiac Failure.
Treatment For Reduced Ejection Fraction
Researchers compared the effectiveness of sacubitril/valsartan with valsartan alone in patients with severe heart failure and a recent history of New York Heart Association class IV symptoms. The double-blind randomized clinical trial Involved 335 patients with severe heart failure. Patients were randomized to either Sacubitril/valsartan (target dose of 200 mg twice daily) or Valsartan alone (target dose of 160 mg twice daily). Results showed no improvement in the number of days alive, out of hospital, and free from heart failure events with sacubitril/valsartan compared to valsartan. Researchers concluded that in patients with advanced heart failure with reduced ejection fraction, there was no significant difference in the effect of sacubitril/valsartan and valsartan alone on NT-proBNP levels.
Valsartan in Chronic Heart Failure
Researchers assessed 5,010 heart failure patients who were given either 160 mg of angiotensin-receptor blocker valsartan or a placebo twice daily. The primary outcomes studied were death rates and a combined measure of death and morbidity, such as incidents of cardiac arrest, heart failure hospitalizations, or receipt of specific heart treatments. The results showed that mortality was about the same in both groups. However, the combined death and morbidity rate was 13.2% lower in the valsartan group than the placebo group. Researchers concluded valsartan can reduce mortality and morbidity in heart failure patients and improve their clinical condition when added to their usual treatment. However, there are concerns about the safety of combining valsartan, an ACE inhibitor, and a beta-blocker.
Candesartan in Patients With Chronic Heart Failure
A study aimed to determine if angiotensin II type 1 receptor blockers combined with angiotensin-converting-enzyme (ACE) inhibitors enhance clinical results for patients with chronic heart failure (CHF). A total of 2,548 CHF patients on ACE inhibitors with a New York Heart Association class of II-IV and a left-ventricular ejection fraction of 40% or lower were randomly assigned candesartan or a placebo. The main measurement for the study was the combination of cardiovascular death or hospitalization due to CHF. After an average of 41 months, Candesartan reduced each of the components of the primary outcome significantly, as well as the total number of hospital admissions for CHF. The study concluded that adding candesartan to ACE inhibitor treatments considerably reduces cardiovascular events in CHF patients with decreased left-ventricular ejection fraction.
