New pharmacotherapy for heart failure with reduced ejection fraction

ABSTRACT

Introduction

The European Society of Cardiology (ESC), Canadian Cardiovascular Society, and the American College of Cardiology Heart Failure (HF) guidelines all currently recommend the use of Angiotensin Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs) and Beta Blockers (BB) in the treatment of HF with a reduced ejection fraction (HFrEF). Newer medications targeting combining an ARB with a neprilysin inhibitor (ARNI) sacubitril/valsartan have shown benefits in mortality and can be used in place of an ACE inhibitor or an ARB. Additionally, dapagliflozin, a medication targeting the sodium-glucose cotransporter 2 (SGLT2) can be used in addition to current therapies.

Areas covered

This review provides a comprehensive analysis of the evidence around the new pharmacotherapies for HFrEF, specifically, sacubitril/valsartan and dapagliflozin. A comprehensive review of the literature using keywords such as heart failure with reduced ejection fraction, angiotensin receptor, neprilysin inhibitor, and sodium glucose transporter was conducted within the National Centre for Biotechnology Information (NCBI) and Google Scholar databases. The reference sections of articles were also examined to find additional articles.

Expert opinion

Sacubitril/valsartan and dapagliflozin both show marked benefits on mortality in HFrEF patients. More research needs to be conducted on the mechanisms of action on disease modification.

KEYWORDS:

• Heart failure with reduced ejection fraction
• angiotensin receptor
• neprilysin inhibitor
• sodium-glucose cotransporter
• dapagliflozin

Article highlights

• Sacubitril/valsartan is a combination drug consisting of a neprilysin inhibitor and an angiotensin receptor blocker.

• Sacubitril/valsartan significantly decreases mortality risk and hospitalization rates in HFrEF patients.

• Dapagliflozin is a diabetes medication that inhibits the sodium-glucose co-transporter in the kidneys.

• Dapagliflozin significantly decreases mortality risk in HFrEF patients.

• There is some evidence to suggest these agents are disease-modifying, observed as improvements in LVEF and other markers of cardiac function and remodeling.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.