Chronic Heart Failure
Heart failure can be acute or chronic. Congestive heart failure is one of three types of chronic heart failure, however, and sometimes the terms can be used interchangeably. The three types of chronic heart failure are left-sided heart failure, right-sided heart failure, and congestive heart failure. Congestive heart failure is typically a stage of chronic heart failure in which fluid backs up into the lungs and tissues. Left-sided heart failure is when the heart is not to properly pumping out blood to the body. Right-sided heart failure is when there are back-ups in the area that collects "used" blood. Right-sided heart failure usually occurs as a result of left-sided failure. Chronic heart failure can be defined as any of these three types of heart failure that progressively worsen over time. In most cases, heart failure is chronic, not acute, which typically occurs due to trauma, allergic reaction, surgery or blood clot. We have focused our research specifically to chronic heart failure to include left-sided, right-sided and congestive.
In the past ten years two drugs have been approved by the FDA specifically for chronic heart failure, both in 2015. An additional drug was approved by the FDA for "chronic coronary or peripheral artery disease." Due to the limited amount of information/drugs/new advancements on the topic being a barrier the research our team focused on researching the drugs that have been approved. Our research team defined "trend" as any innovation or traditional first line therapies that are still being widely used that was mentioned by at least two credible sources such the American Heart Association, the FDA, or Heart.org, or NCBI.
TREND #1 - THE FIRST USE OF A HCN BLOCKER to treat chronic heart disease
Corlanor (ivabradine) was approved by the FDA in 2015, specifically for chronic heart failure. It is a drug that is typically prescribed for patients with heart failure that is caused by problems in the heart’s lower left chamber, patients with normal heart rates, and patients whose heart rate is not controlled by beta-blockers or patients that cannot take beta-blockers. It is the first HCN Channel Blocker. The drug works to treat chronic heart failure by inhibiting specific channels in the SA node, which slows the patient's heart rate.
TREND #2- The first use of an angiotensin receptor neprilysin inhibitors to treat chronic heart disease
Sacubitril/Valsartan (Entresto) is a new medicine that is prescribed to shorten a patient's time in the hospital. It was approved by the FDA in 2015 and is the "first in a new class of drugs called angiotensin receptor neprilysin inhibitors, or ARNIs." However, it cannot be used with ACE inhibitors. It was approved specifically for chronic heart failure. Sacubitril inhibits an enzyme called neprilysin, which is used to reduce blood volume. Lower blood volume results in lower blood pressure.
TREND #3 NEW BLOOD THINNER FOR CHRONIC HEART DISEASE BEING PRESCRIBED BY PHYSICIANS
In 2018, Xarelto (rivaroxaban) was approved by the FDA. It is used to treat "chronic coronary or peripheral artery disease." It can reduce the effect of major cardiac events by 24%, when used in combination with aspirin. Data also showed, "a 42% reduction in stroke, 22% reduction in CV death and 14% reduction in heart attack." Xarelto reduces the formation of fibrin (which binds platelets together), which means the patient is less likely to get a blood clot.
TREND #4 NEW TECHNOLOGY IN Cardiac resynchronization used with drug therapy
Cardiac resynchronization is currently being used with drug therapy to achieve maximum patient results. Cardiac resynchronization therapy is small pacemaker that is implanted into the patient and helps the patient's heart rhythms stay regular. It can send electric pulses on the patient's ticker surface, meaning fewer adjustments. CRT is for heart failure patients with moderate to severe symptoms and whose left and right heart chambers do not beat in unison. It is not effective for diastolic failure. It treats arrhythmia, especially atrial fibrillation by improving ventral synchrony. According to NCBI, " a number of technological advances have already contributed to achieve some objectives of modern CRT. They include novel lead design (the left ventricular quadripolar lead, and multipoint pacing), or the possibility to go beyond conventional delivery of CRT (left ventricular endocardial pacing, His bundle pacing)."
TREND #5 OLDER Pharma drugs still being used
According to Heart.org, anticoagulants, antiplatelet agents and dual antiplatelet therapy, ACE Inhibitors II, receptor blockers, angiotensin-receptor neprilysin inhibitors, beta blockers, calcium channel blockers, cholesterol-lowering medications, digitalis preparations, diuretics, and vasodilators are currently the most common medications prescribed to treat chronic heart failure. A full list with descriptions can be viewed here. Due to the lack of recent FDA approvals, many older medications are still being prescribed by doctors to treat chronic heart failure. Out of all medications presented to the FDA, only two in the past 10 years have been approved specifically for chronic heart disease.
Heart medications that were recently approved include Xarelto in 2018 (treatment of chronic coronary or peripheral artery disease), Bevyxxa in 2017 (treatment of (prophylaxis of venous thromboembolism), Byvalson in 2016 treatment of hypertension), and Yosprala in 2016 (prevention of cardiovascular and cerebrovascular events). A complete list for the past 14 years can be viewed here.