Optimizing the management of patients with worsening heart failure: beyond heart failure hospitalization

ABSTRACT

Introduction

Worsening heart failure (HF) is associated with a high risk of death and HF hospitalization.

Areas covered

A systematic search was conducted on PubMed (MEDLINE), using the MeSH terms [Heart failure] + [Worsening] + [Treatment] + [Vulnerable period] up to February 2023. Original data from clinical trials, and observational studies were critically analyzed.

Expert opinion

Although the vulnerable period has been traditionally limited to the first 6 months after HF hospitalization, the fact is that there are other clinical scenarios in which the patient is particularly vulnerable. These vulnerable patients may also include those that require parenteral administration of diuretics in the day hospital or emergency department, those in which the increase of oral diuretic dose in an outpatient setting is needed to relief congestive symptoms, as well as those that remain symptomatic despite treatment. On the other hand, HF is a complex disease in which different neurohormonal systems are involved. Therefore, to actually reduce the HF burden, a comprehensive management, targeting all the neurohormonal systems that are involved in the pathogenesis of HF, through the use of those drugs that have demonstrated to positively modify the clinical course of HF, is needed.

KEYWORDS:

• Heart failure with reduced ejection fraction
• sacubitril-valsartan
• SGLT2 inhibitors
• treatment
• vericiguat
• vulnerable period
• worsening heart failure

Article highlights

• Worsening HF is associated with a high risk of death and HF hospitalization.

• Worsening HF identifies a vulnerable period where the early optimization of HF treatment through a comprehensive management and targeting of all the neurohormonal systems that are involved in the development of HF is crucial.

• This vulnerable period should include different clinical scenarios, including HF hospitalization, patients requiring parenteral diuretics, increasing the dose of diuretics or those that remain symptomatic despite treatment.

Ackowledgments

Writing and editorial assistance was provided by Content Ed Net (Madrid, Spain).

Declaration of interest

A Esteban Fernández has received honoraria as a speaker from Novartis, Boehringer Ingelheim, Vifor Pharma, Fresenius Krabi, and Bayer. He has received research grants from Novartis and Boehringer Ingelheim.

A Recio Mayoral has received honoraria for lectures from Astra-Zeneca, Bayer, Boehringer-Ingelheim, Janssen, MSD, Novartis and Rovi; participation in advisory boards from Bayer, Janssen, MSD and Novartis; support for attending meetings from Bayer, Boehringer-Ingelheim, Janssen and Novartis.

A González Franco has received honoraria for lectures from Astra-Zeneca, Boehringer-Ingelheim, Rovi, Vifor Pharma, Lilly and Novartis; participation in advisory boards from Bayer, Boehringer-Ingelheim, Astra-Zeneca and Novartis; and support for attending meetings from Pfizer, Bayer, Boehringer-Ingelheim, Astra-Zeneca, Boehringer-Ingelheim, Rovi and Novartis.

J Núñez Villota reports personal fees from Astra Zeneca, Novartis, Boehringer-Ingelheim, Eli Lilly, Rovi, NovoNordisk, Vifor Pharma, and Bayer.

S Mirabet has received honoraria for lectures from Boehringer-Ingelheim Lilly, Rovi, Novartis and Astra-Zeneca; participation in advisory boards from Bayer and Boehringer-Ingelheim; support for attending meetings from Boehringer-Ingelheim, Novartis, Vifor, Abbott and Alnylam.

J González Costello has received honoraria for lectures from Abbott, Pfizer, Alnylam, Boehringer-Ingelheim, Zoll, Rovi and Astra-Zeneca; participation in advisory boards from Abbott, Chiesi, Pfizer, Alnylam, Novartis, Bayer and Astra-Zeneca; support for attending meetings from Abbott, Astra-Zeneca, Zoll and Alnylam.

JL Bonilla Palomas has received support from Bayer, Rovi, Pfizer, Boehringer Ingelheim, Lilly, AstraZeneca and Novartis for research projects, lectures and/or participation in advisory boards.

C Escobar Cervantes has received honoraria as a speaker from Astra-Zeneca, Novartis, Boehringer Ingelheim, Vifor Pharma, Rovi and Bayer.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by Bayer Hispania