New Hope for Heart Failure with Preserved Pumping Function
Up until very recently, treatment for this type of heart failure was symptomatic. We had no treatments that modified disease progression and saved lives. That has changed. Forty percent of patients with heart failure with preserved ejection fraction (heart failure preserved ejection fraction-HFpEF-”hefpef”) have resistant hypertension. Patients with resistant hypertension who were treated with spironolactone or eplerenone were 30% less likely to die or be hospitalized. SGLT2 inhibitors reduce death and hospitalization by 21%. With this new information, we can dramatically improve care.
Therefore, the protocol for HFpPF includes spironolactone or eplerenone in patients with resistant hypertension or systolic pressure over 130, powerful fluid pills for symptoms, and SGLT2 inhibitor therapy. Getting this right is critical because one out of five of us will develop heart failure in our lifetime and it generates one third of Medicare expense. The number of us with heart failure is still increasing. Optimal medical therapy over 20 years lowers heart failure hospitalizations by 70% without regard to pumping function.
There is a basic set of facts to be considered here. Scar tissue formation is central to HFpEF development and this is the core disease. It begins years before the patient develops symptoms. When heart muscle is replaced by scar, it becomes stiff. The pumping chambers of the heart cannot fill adequately and the amount of blood pumped drops. Clinical trials are short. Congestive heart failure develops over years. Some kinds of scar tissue can slowly reverse.
The diagram above helps explain the causes of the scar formation. Angiotensin II, aldosterone, and oxidant production are increased in this type of heart failure. Growth factors like transforming growth factor beta (TGFB) are inappropriately switched on. TGFB can be substituted for EGFR in the central purple box in the diagram. Nitric oxide effects are reduced and increased ADMA levels correlate with poor outcomes in this condition. Increased ADMA is a marker for switching on genes that should be quiet related to the factors above. Metformin blocks the effect of ADMA. Optimal medical therapy for conditions like diabetes, hypertension, and coronary artery disease interfere with this molecular biology and stop scar tissue formation. If you, or someone you care about, has heart failure, learn about optimal medical therapy on this site. If your organization is struggling with heart failure readmissions, let’s work together to solve that problem. We could do a much better job for these patients. We can help you with a comprehensive solution that consistently produces optimal medical therapy.