Download Volume 1, Issue 1, January 2017

4th Congress of
WHFS
Drugs in chronic HF: the
olds, the news and those
coming
Journey HF-TR
In memory of Prof.
Dr. Henry Krum
Page 1-3
Page 3,4
Page 5,6
Page 6,7
Newsletter
Volume 1, Issue 1, January 2017
World Heart Failure
Society Board Members
Albertino Damasceno
Babak Sharif-Kashani
Bambang Budi Siswanto
Byung-Hee OH
Cheuk Man Yu
Dong Zhao
Elsadig Kazzam
Felipe Martinez
Gilson Feitosa
Inder Singh Anand
Kewal Krishan Talwar
Masatsugu Hori
Mehdi Zoghi
Siddiq Ibrahim Khalil
Siddiq Reddy
Simon Stewart
Thikayat A Noorudin
Willem J. Remme
Yura Mareev
The World Heart Failure Society’s Newsletter is published online every 3
months. Each issue features news and updates on diagnosis and
management of heart failure, multicenter clinical study and/or
questionnaires initiatives on field of heart failure for all health
professionals. You can also find a column for announcement of your
studies, congresses and case presentations.
4th Congress of WHFS
Welcome to the first issue of
WHFS-Newsletter!
In this issue, we have focused
on 4th WHFS Congress.
Prof. Dr. Cheuk Man Yu gave
some information about the
congress.
Prof. Dr. WJ. Remme, the
founder of World Heart
Failure Society, also wrote in
memory of Prof. Henrry
Krum, one of the active
members of WHFS, who
passed away 2 years ago.
The results of JourneyHF-TR
are presented by Dr. Ümit
Yaşar in “Your Column”
section.
Prof. Dr.
Cheuk Man Yu
As the Immediate Past President of
the World Heart Failure Society
(WHFS), I am proud and delighted to
conclude that the Fifth World Heart
Failure Congress (WHFC 2016) was
successfully held on 14-16 October
2016 at Beijing, China. In the WHFC
2016, we are particularly honoured
that the congress was conjoint with
27th
Great
Wall
International
Congress of Cardiology (GW-ICC
2016).
The WHFC 2016 had provided a
unique platform that has united
physicians, allied health and research
professionals from around the world
who are involved in the field of heart
failure. The 3-day congress had
covered all facets of heart failure.
These included clinical trials in
pharmacotherapy, device therapy,
surgical management, interventional
and novel therapeutics, heart failure
rehabilitation, risk factors and
prevention, acute decompensated
heart failure, heart failure with
preserved ejection fraction, imaging
for heart failure, basic research,
biomarkers, and more.
Our speakers comprised a balanced
mix between renowned international
faculties and board members of WHS,
as well as eminent cardiologists from
China and Asia.
As management of heart failure is gaining widespread
recognition by cardiologists in China, the meeting hall for
WHFC 2016 was full of enthusiastic audiences.
In WHFC 2016, there was detailed presentation and
extensive discussion on how heart failure treatment
guidelines can be applied to developing countries,
innovative heart failure implantable technologies such as cardiac contractility modulation,
PARACHUTE devices, stem cell therapy, drugs under development, and multidisciplinary
approach for heart failure management. Board members of WHFS will summarize some of these
key topics in the upcoming Newsletters and thanks to their great efforts. During the Opening
Ceremony, I have pointed out that heart failure has become a world-wide endemic including the
developing countries.
Therefore, the WHFS has been dedicating its
effort in helping cardiologists in these
regions to develop their heart failure
management programs and training of heart
failure physicians. I would like to thank the
GW-ICC again for collaborating the
organization of our WHFC 2016 in China. In
particular, I have to express my gratitude to
the Board Members of WHFS for their
dedicated effort in supporting the Congress.
I am glad that I could meet some of the
members of the WHFS in person during my
stay in Beijing, and again thank you for your
participation to the Congress. In Year 2017,
may I wish all members of WHFS a happy,
healthy and successful year to come.
Drugs in chronic HF: the olds, the news
and those coming
Prof. Dr. Felipe Martinez
Most of international registries proved that
approximately 1–2% of the adult population
has heart failure (HF) in developed
countries, with the prevalence rising to
≥10% among persons 70 years of age or
older. These numbers are even higher in
regions with low socioeconomic conditions.
There are many causes of HF, and these
vary in different parts of the world.
Coronary artery disease (CAD) is the cause
of approximately two-thirds of cases of
systolic HF. Hypertension and diabetes are
probable contributing factors in many
cases.
The above scenarios justify the large
amount in research with the goal of
discovering new drugs. The main goals are
prevention, relief of symptoms and signs
and improve survival. During the last 30
years many drugs have proved clear
benefits in reducing outcomes and
mortality and they are in use in most
Countries around the world.
This article reviews the pharmacologic treatment
of chronic HF with reduced EF only and focusing in
new drugs and some key compounds that appear in
the horizons and are supporting the idea that HF is
now becoming a preventable and treatable disease
(Figure 1).
Figure 1: List of main group of drugs with proved
benefits in the reduction of outcomes and
mortality in heart failure (HF) patients. ACEI=
angiotensine converting enzyme inhibitors. BB=
beta blockers. MRA= mineralocirticoid receotor
antagonists. ARB= angiotensin receptor blockers.
NEW DRUGS IN RECENT GUIDELINES
In the past couple of years the evidence of new
compounds and/or new mechanisms stimulates the
need of Guidelines. Probably the 2016 version of
the European Society of Cardiology is which
reflects the most updated approach in this field.
1) Mineralocorticoid Receptor Anatgonists (MRA):
Almost 50 years after its approval, spironolactone
had a revival of great impact with the results of
RALES.
3
The initially so called “aldo blockers” group
includes eplerenone and most recently
finerenone. And these drugs are now
recommended as first line indications in
some types of HF, mainly chronic and post
myocardial infarction. What are the reasons
of this consolidated
recommendation in
most of the recent international guidelines?
There are two main causes: a)The growing
role of the mineralocorticoid receptor in the
pathophysiology
of
cardiometabolic
disorders, and in particular HF. b) The
increased selectively in the pharmacologic
antagonism of new compounds of the group.
In summary, the MRA group of drugs has
reached enough evidence to be prescribed in
all NYHA class of chronic HF with reduced EF
and post MI. 2) SRAA dual inhibition: This
interventional strategy has been explored
since many years ago and with different
pathways. There were several failures, the
most important was omapatrilat that
inhibited
the
ACE
and
neprilysin
simultaneously, but the adverse events
observed in Phase III were enough to take
the drug off. In 2014 the PARADIGM Trial was
published and changed the history (Figure 3).
This study compared LCZ696, a compound
with a dual inhibition of the ATII receptor
(valsartan) and a
neprilysin inhibitor
(sacubitril) versus enalapril on top of usual
treatment for patients with chronic HF. The
trial was stopped before the end due to the
great difference in lowering mortality in the
group receiving the study drug. The
surprising results were consistently repeated
in all subgroups and in all regions were the
study was performed. 3)Glifozines or Sodium
GLucose Transporter 2 inhibitors (SGLT2 I):
This group of drugs was approved by most of
the Regulatory Agencies for the treatment of
Type II diabetes. Surprisingly in one of the
largest Phase III studies, the EMPA-REG Trial,
a significant lower incidence of heart failure
was observed in the group of patients
receiving empaglifozine, one of the five
drugs approved in this group.
Figure 3: The PARADIGM Trial. Primary Endpoint
Despite of the evidence that these new compounds
have a diuretic effect, many other beneficial
effects on the cardiovascular system have been
described, and still need more research. But after
the provocative results published in EMPA-REG, the
pharmacy industry has launched important
programs to confirm if these drugs have very
positive mechanisms to prevent and treat HF and
also renal dysfunction in diabetics and nondiabetics patients. If the potential benefits are
confirmed the new group will become a very useful
tool for the management of HF. 4)What is in the
pipe line?
There is a long list of drugs under research for the
treatment of HF. Many of them are also in studies
including hypertensive patients, as it has happened
in the past. Since the role of the RAAS in the
pathogenesis of both diseases is very inportant, it
is not a suprise that many of the investigatid
compounds are direct or indirect intervention in
that system.
CONCLUSIONS:
1) “Old drugs” still in use have demonstrated clear
benefits lowering morbidity and mortality in HF.
2) New compounds show solid evidence in
improving the above , mainly in chronic HF.
Among others, the most outstanding are: MRA and
ARNI.
3) There are ongoing optimistic studies with more
new drugs that could even increase the benefits in
patients with HF.
4
Patient Journey in Hospital with Heart
Failure in Turkish Population: on behalf of
Journey HF-TR study investigators
Dr. Ümit Yaşar Sinan
Heart failure (HF) is one of the most
important causes of morbidity and mortality
in the world. The prevalence is 0.4 to 2% in
general European population and 5 million
Americans with chronic HF are mostly
attributable to inpatient hospitalization.
Acute exacerbation of chronic HF is a lifethreatening clinical syndrome characterized
by rapid onset of HF symptoms and signs and
requires urgent therapy. Patients with acute
HF (AHF) have poor short and long-term
prognosis. In-hospital mortality rate is high in
AHF patients due to medical therapy and
remains high after discharge. The surveys and
registries provide valuable information
regarding epidemiology, outcomes of realworld and better understanding of medical
practice in this clinical condition. In this
study, we aimed to evaluate the overall
clinical characteristics, management and inhospital outcomes (from ICU admission to
discharge) of hospitalized patients with AHF
in Turkish population.
The Journey HF-TR study is a cross-sectional,
multicenter, non-invasive and observational
trial that was conducted in ntensive/coronary
care units and cardiology wards. We enrolled
a total number of 1,606 patients in 39
centers, in seven geographical regions of
Turkey.
The patients who
were hospitalized with
the diagnosis of acute
heart failure in
intensive/coronary care
units
between
September 2015 and 2016
were included in our study.
1606 patients
(male: 57.2%, mean age was 67.8±13 years old)
who were diagnosed with AHF in 37 centers, in
seven geographical regions of Turkey were
enrolled in this study.
Hypertension (67%), coronary artery disease
(59.6%) and diabetes (41.9%) were the most
frequent underlying diseases. Anemia (using
WHO definition: Hb <13.0 g/dl for males and Hb
<12.0 g/dl for females) was detected in 48.1% of
the patients. Chronic kidney disease (CKD)
(defined as glomerular filtration rate-GFR- <60
ml/min/1.73m2) was detected in 28.2% of the
patients. Most frequent arrhythmia was atrial
fibrillation (39%). Seventeen percent of patients
were admitted to hospital with diagnosis of new
onset AHF (de novo AHF) and 83% of patients
were admitted with diagnosis of ADCHF. The
75.2% patients were in NYHA class III-IV.
Biomarkers were used in 41% of patients at
admission for diagnosis. Echocardiography was
available in 92% of the patients and was
performed averagely in three days after
admission. Most of the patients (64%) had EF
lower than 40% (defined as heart failure with
reduced EF-HFrEF). The rest of the patients
were consisted of heart failure with mid-range
EF (HFmrEF) (19%) and HF with preserved EF
(HFpEF) (17%). The prescription of guideline
recommended medications were often more at
discharge: Diuretics (from 71% to 81%), ACE
inhibitors or ARBs (from 62% to 81%), betablocker (from 73% to 87%) and MRAs (from 39% to
60%). The median length of stay (LOS) in ICU was
3 days (IQR 1-72), in general or cardiology ward
was median 4 days (IQR 1-62).
In-hospital mortality rate was 7.6%.
5
The Journey HF-TR database is providing
valuable and up-to-date information on
demographics, characteristics, and
underlying condition of AHF patients as well
as etiology, investigation and treatment
practices of AHF in Turkey. Analyses of data
provide to observe compliance with the
current ESC guidelines proposal on
management of AHF and will help preparing
a national database and distinctive diagnosis
and treatment algorithms. The one-year
follow-up data will be collected and these
data will provide further improve for HF
care in Turkey.
In memoriam Prof. Henry Krum, 1958–2015
By Prof. Dr. Willem J. Remme
Prof. Henry Krum, 1958–2015
Whereas basic cardiovascular pharmacology
in which he started, always remained an
important element , Henry Krum had the
opportunity to follow a post-doctoral
fellowship at Columbia Presbyterian Medical
Centre in New York headed by Professor
Milton Packer, a leading expert in large-scale
clinical trials in heart failure.
This episode laid the basis of his later career
as one of the world’s most important pioneer
in the conduct of controllled clinical studies
in heart failure, hypertension, and diabetes
and renal dysfuncion in relation to heart
failure.
At the occasion of the
publication of this first Newsletter of the
World Heart Failure Society we wish to
commemorate Professor Henry Krum, one of
the founding members of the Society, who
died on November 28, 2015, at the age of 57
from pancreatic neuroendocrine cancer.
Henry Krum was born in Melbourne, Australia.
He started his medical studies at the
Melbourne University in 1976, and
subsequently trained and obtained a PhD as
clinical pharmacologist.
Back in Melbourne, Henry Krum founded the
Monash Centre of Cardiovascular Research
and Education in Therapeutics, an Institute
that under his leadership became wellknown in the international scientific arena,
and from which he supervised an endless
production of scientific publications in highranking journals, and tutored many young
trainees in both basic and clinical
pharmacology of heart failure.
6
During his life Henry Krum has been involved in many crucial heart failure studies as a member or
Chairman of Steering Committees and in this position has played a fundamental role in our
recognition of beneficial effects of beta-blockers , renin-angiotensin inhibitors and aldosterone
antagonists in heart failure, the cornerstones of current medical therapy. Moreover, Henry Krum
had an interest in hypertension and published on the effectiveness of renal denervation on blood
pressure reduction in patients with resistant hypertension. His more recent focus was on the role
of co-morbidities in heart failure, including diabetes and chronic kidney disease, and the
potential role of neurohormonal inhibition in these areas.
Henry Krum was an excellent scientist. He was also a very amiable person with great interest in
his companions and friends. Plagued by back trouble he would often stand for periods on end
during our meetings, but would never complain, instead remained joyful and attentive. He saw
this as his personal problem, not one that should be a concern of others.
Henry Krum was also greatly interested in new developments. When approached at a very early
stage in our setting up of the World Heart Failure Society, he immediately and enthusiastically
accepted to become a member of the newly founded Steering Committee and became very much
involved in the creation of the Society. His suggestions how to proceed and his direct input in
this, have been very valuable for us in our efforts to develop the Society into what it currently
has become.
He was truly an asset for the World Heart Failure Society and will be very much missed by us.
Prof. Mehdi Zoghi, MD, FESC
Ege University, cardiology Dpt. İzmir-Turkey
[email protected]
http://www.worldheartfailure.org