Heart Failure

Question 1

What are main treatments for LV systolic dysfunction?

Answer 1

A - angiotensin receptor neprilysin inhibitor (ARNA)
BB - beta blockers
A- aldosterone receptor antagonist

Question 2

What is sacubitril?

Answer 2

Prodrug neprilysin inhibitor

Inhibits enzyme that degrades natriuretic (and other vasoactive) peptides

Question 3

What is the evidence for sacubitril/ valsartan?

Answer 3

PARADIGM-HF trial showed that compared to enalapril, sacubitril/ valsartan reduced death from cardiovascular causes and first hospitalisation for worsening heart failure by 20%

Question 4

What is the indication for sacubitril/ valsartan?

Answer 4

NICE Technology Appraisal 2016

• congestive heart failure due to LV systolic dysfunction with EF < 35%
• stable on optimum therapy
• stop ACE
• start sacubitril/ valsartan 48 hours later
• initiated by specialist HF team only

Question 5

What is ivabradine?

Answer 5

Selective inhibitor of ‘funny’ channel pacemaker current in the SA node in a dose-dependent fashion, resulting in reduced heart rate

Question 6

What is the evidence for ivabradine?

Answer 6

SHIFT trial showed that compared to placebo, ivabradine reduced hospital admissions for heart failure and deaths due to heart failure by 25%

Question 7

What is the indication for ivabradine?

Answer 7

NICE Technology Appraisal 2012

• congestive heart failure due to LV systolic dysfunction with EF < 35%
• on standard therapy (ACE-I, B-blockers, aldosterone receptor antagonist OR intolerant of b-blockers OR b-blockers contraindicated
• in sinus rhythm with heart rate of 75 beats per minute or more
• initiated by specialist HF team