By Stacey Butterfield
Internists should be feeling pumped up about heart failure, according to Clyde W. Yancy, MD, MSc, MACP, a cardiologist and professor of medicine at the Northwestern University Feinberg School of Medicine in Chicago.
There’s so much new to report that his Update in Cardiology session at Internal Medicine Meeting 2021: Virtual Experience, available at 9:15 a.m. on Thursday, focuses entirely on this one condition. “This really has been a robust period of discovery in heart failure—new drugs, new trials, new data points,” said Dr. Yancy in a recent interview.
Even aspects of the disease as basic as its definition have changed. “It's actually quite provocative, this new definition of heart failure,” said Dr. Yancy, who was an author of the revised, “more crisp” definition, published online March 1 by the Journal of Cardiac Failure. “We can say who has the disease, but guess what? We can also say who doesn't. Imagine the relief a patient has when you don't have to describe them as having heart failure. … That's not an easy thing to digest, so exercising more precision with the definition has been a critically important piece.”
Then there are the new drugs. As he describes in the above video, Dr. Yancy is particularly excited about the potential of sodium glucose cotransporter 2 (SGLT-2) inhibitors to improve heart failure outcomes. “Wow,” he said.
The drug class became a first-line therapy for heart failure in the 2021 update to the American College of Cardiology (ACC) expert decision pathway, noted Dr. Yancy, a coauthor of the guidance who reviews the bevy of recent trials of SGLT-2 inhibitors and heart failure.
That doesn’t mean the old heart failure drugs should be forgotten. And they often are, according to a 2019 study finding that less than a quarter of outpatients with heart failure with reduced ejection fraction were receiving appropriate doses of any of the recommended medications.
Dr. Yancy will offer his perspective on improving use of guideline-directed medical therapy, including some novel methods to achieve that goal, such as machine learning and polypills. He also wants to “tease” the new heart failure guidelines, which are expected soon from the ACC and the American Heart Association. “We'll be able to see that this is a new day in heart failure,” he said. ■