Heart failure is clearly syndromic, with several phenotypes, so it will remain challenging to reconcile patient to therapy until these unique phenotypes can be studied, stated Clyde W. Yancy, MD, MSc, of Northwestern University’s Feinberg School of Medicine.
Heart failure is clearly syndromic, with several phenotypes—cardiopulmonary, cardiorenal, cardiometabolic—so it will remain challenging to reconcile patient to therapy until we can begin to study these unique phenotypes and a priori identify them, stated Clyde W. Yancy, MD, MSc, professor of medicine, chief of cardiology, and vice dean for diversity and inclusion at Northwestern University’s Feinberg School of Medicine.
Yancy presented “Evolving Understanding & Therapeutic Role of SGLT2i and ARNI in 3 Heart Failure Phenotypes: HFrEF, HFiEF & HFpEF” on day 1 of ACC.21.
Transcript
Why have treatments for heart failure with preserved ejection fraction been so elusive?
Because as you begin to think about the most important new therapies for heart failure—the ARNI [angiotensin receptor neprilysin inhibitor] compound and the SGLT2 [sodium-glucose cotransporter-2] inhibitor—we can exercise the opportunity to position these new drugs in which of those 3 phenotypes where there might be evidence of benefit.
Let's start with the ARNI compound. We know for certain, let me emphasize for certain, the ARNI compound is appropriate for reduced ejection fraction heart failure. Well, we also have a very intriguing piece of data and a very important prespecified secondary analysis from PARAGON-HF. The investigators brought forth very important information.
For those patients with symptomatic heart failure with an ejection fraction less than 57%, there was clear evidence of the benefit from the ARNI compound. Now, this was not a prospectively powered subgroup. It was a prespecified analysis, so it is at least suggestive of benefit and gives us kind of a fill-in-the-blank for that intermediate-range ejection fraction.
Now to extend the response as to why we’ve had difficulty finding agents for heart failure with preserved ejection fraction—understanding that we cannot yet place the ARNI compound in that space because the clinical trial was neutral—the reason we've had difficulties is that we know that heart failure with preserved ejection fraction is not one disease, it’s not one syndrome, because heart failure clearly is syndromic. It’s probably several different phenotypes. One is cardiopulmonary, one is cardiorenal, one that we typically see often in the office is cardiometabolic. And so until we can begin to study the unique phenotypes and have a way of a priori identifying the phenotypes, it will continue to be a challenge to reconcile how best patients will respond to individual therapies.
So we're still on the elusive search for that agent that is, without question, effective in all-comers with heart failure with preserved ejection fraction. Previously, I would have said I didn't think was possible. But given the traction we've seen what the sodium-glucose cotransporter-2 inhibitors and knowing that a trial is ongoing, looking at the use of the SGLT2 inhibitor in heart failure with preserved ejection fraction, it might happen. And importantly, the answer to that question using empagliflozin will be available later in calendar year 2021. That could be a breakthrough if that’s positive.
Safety and Efficacy Updates for Asthma and Urticaria Therapies
April 5th 2025The long-term safety and efficacy of omalizumab, alongside promising phase 3 trial results that demonstrated the efficacy and favorable hematological safety profile of remibrutinib, were highlighted at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
Read More
Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
Listen
High-Impact Trials at ACC.25 Signal Shift in Chronic Disease Treatment
April 4th 2025Experts highlight groundbreaking research presented at the American College of Cardiology Annual Scientific Session (ACC.25), which emphasized a shift toward more personalized, evidence-based treatment strategies.
Read More
The Push for Fair Pricing and Reform in Pharmacy Benefit Management
April 3rd 2025Amid growing legislative pressures and industry debates, pharmacy benefit managers (PBMs) are exploring new strategies to enhance transparency, reduce patient costs, and navigate the evolving healthcare landscape.
Read More
How Pharmacy Deserts, Biosimilars, and Market Trends Are Shaping Managed Care
April 2nd 2025Rising biosimilar adoption, shifting market dynamics, and escalating supply chain vulnerabilities are driving change in managed care, creating both challenges and opportunities for stakeholders, as explored by speakers at the Academy of Managed Care Pharmacy’s annual meeting.
Read More