9/27/2016
What’s New In The World Of Heart Failure? Sandra L Chase, BS, PharmD, FCCP Senior Medical Science Liaison Otsuka Product Development & Comm...
What’s New In The World Of Heart Failure? Sandra L Chase, BS, PharmD, FCCP Senior Medical Science Liaison Otsuka Product Development & Commercialization, Inc.
Learning Objectives Pharmacist: - Explain the mechanism of action of the new medications approved for the management of heart. - List the indications, adverse effects, and drug interactions for the new medications approved for the management of heart failure. - Explain the role of the new medications in the updated “Guidelines for the Management of Patients with Heart Failure” in order to provide evidence based medical care for patients.
Pharmacy technician: - Explain how the new medications work and how they compare to currently approved medications. - List the major adverse effects of the new medications approved for the management of heart failure. - Identify major drug interactions of the new medications for the management of heart failure.
Patient Case AR is a 65 year old Caucasian male patient with stage C, NYHA class II heart failure and a reduced ejection fraction (EF 35%) secondary to ischemic cardiomyopathy. Today he presents to clinic for routine follow up. - Vitals: BP 132/75, HR 86, wt 76 kg - Medication profile:
137
102
22
4.2
27
1.2
102
Lisinopril 20 mg daily
Aspirin 81 mg daily
Carvedilol 25 mg twice daily
Atorvastatin 80 mg daily
Eplerenone 25 mg daily
Furosemide 20 mg daily
Digoxin 125 mcg daily
Omeprazole 20 mg daily
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Patient Case AR is a 65 year old Caucasian male patient with stage C, NYHA class II heart failure and a reduced ejection fraction (EF 35%) secondary to ischemic cardiomyopathy. Today he presents to clinic for routine follow up. - Medication profile:
Which of the following medication changes would you make for this patient? A. Increase lisinopril to 40 mg daily B. Switch lisinopril to sacubitril/valsartan 49/51 mg twice daily C. Increase carvedilol to 37.5 mg twice daily D. Add ivabradine 5 mg twice daily
Epidemiology of Heart Failure Heart Failure (HF) currently afflicts over 5 million Americans . Approximately 500,000 HF-related deaths each year in the United States. Most common cause for hospitalizations in patients over age 65. Significant cause for rehospitalization. In 2012, the total cost for HF was estimated to be $30.7 billion. Of this total, 68% was attributable to direct medical costs. Projections show that by 2030, the total cost of HF will increase almost 127% to $69.7 billion from 2012. This equals ≈$244 for every US adult. Circulation 2015;13:e29-322.
% of US population
2012 US Prevalence of Heart Failure
• 5.7 million Americans > 20 years of age were living with HF in 2012 • Projections show that the prevalence of HF will increase 46% and by 2030 > 8 million people > 18 years of age will have HF American Heart Association. Heart Disease & Stroke Statistics. 2015 Update. Dallas, TX: American Heart Association, 2015.
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Heart Failure: Here to Stay? Principle discharge Diagnoses for Medicare fee-for-service beneficiaries hospitalized in 1999 and 2013
JAMA 2015;314:355-365.
Dawn of a New Era…? "I think this is exciting and is a great new hope for our heart-failure patients…" Dr. Mariell Jessup (University of Pennsylvania)
"This is a large trial with convincing results and will be important for clinical practice. We're hoping for great things." Dr. John G Cleland (Imperial College London)
"I think they considered the data to be compelling and strong. And I think that when physicians look at the data, they will be convinced that this drug will become a cornerstone of treatment for heart failure.” Dr. Milton Packer (University of Texas Southwestern) http://www.medscape.com/viewarticle/848657#vp_3
Dual Inhibition of the Neuroendocrine System in Chronic Heart Failure
Neprilysin Inhibition: Two Decades of Progress Candoxatril (1999) • No effect on BP or SVR Abandoned Ecadotril (1998) • Numerically more deaths Abandoned Omapatrilat: inhibits neprilysin and ACE (2004) • Equivalent to enalapril, angioedema Abandoned
JACC Heart Fail 2014;2:663-70.
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Dual Neuroendocrine Inhibition SNS
RAAS Heart Rate Beta-blockers BP Remodeling