2. Definitio
n
• HF is a complex clinical syndrome that
results from any structural or functional
impairment of ventricular filling or
ejection of blood.
3. Epidemiolog
y
• The lifetime risk of developing HF is 20% at 40 years
of age.
• HF incidence: >650 000 new HF cases diagnosed
annually
• HF incidence increases with age, rising from
approximately 20 per 1000 individuals 65 to 69 years of
age to >80 per 1000 individuals among those >85 years
of age.
• Mortality rates for HF remain approximately 50%
within 5 years of diagnosis
4. 1. Mozaffarian D et al. Circulation. 2015;131(4):e29-
e322. 2. Mosterd A et al. Heart. 2007;93(9):1137-
1146.
3. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-
Conditions/Downloads/2012Chartbook.pdf
4.Cowie MR et al. Oxford PharmaGenesis; 2014. http://www.oxfordhealthpolicyforum.org/AHFreport. Accessed February 18, 2015.
5.Fauci AS et al. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-
Hill; 2008. 6. Cook C et al. Int J Cardiol. 2014;171(3):368-376.
NUMBER of PATIENTS
21 MILLION adults worldwide are
living with heart failure
This number is expected to
rise.1,2
REHOSPITALISATION
Heart failure is the NUMBER 1
cause of hospitalisation for
patients aged >65 years.4
MORTALITY
50% of heart failure patients die
within 5 years from diagnosis.5
COMORBIDITIES: The vast
majority of HF patients has 3 or
more comorbidities 3
ECONOMIC BURDEN
In 2012, the overall worldwide
cost of heart failure was nearly
$108 BILLION.6
The burden of heart
failure
6. Overview of HF staging
system
High Risk for Developing HF
Hypertension
CAD
Diabetes mellitus
Family history of cardiomyopathy
Symptomatic HF
Known structural heart disease
Shortness of breath andfatigue
Reduced exercise tolerance
Asymptomatic HF
Previous MI
LV systolic dysfunction
Asymptomatic valvular disease
Refractory
End-Stage HF
Marked symptoms at rest
despite maximal
medical therapy
A
B
C
D
Hunt SA et al. J Am Coll Cardiol.2001;38:2101–2113.
8. HFpEF vs. HFrEF
Heart failure with
preserved ejection
fraction
“Diastolic HF”
HFpEF HFrEF
Heart failure with
reduced ejection
fraction
“Systolic HF”
Left
ventricle
Left
ventricle
9. HFpEF vs. HFrEF
Poorly understood
Increasing in prevalence
No definitive treatments
High morbidity/mortality
Well studied
Decreasing in prevalence
Many proven treatments
Decreasing morbidity
Decreasing mortality
10. • Prevalence of HFpEF among patients with a discharge diagnosis of HF
increased from 38% to 54% from 1987–20011
• Increasing prevalence of HFpEF may be a consequence of growing
recognition, population aging and increases in hypertension and
obesity2
Patients
with
preserved
ejection
fraction
(%)
1986 1990 1994 1998 2002
70
r=0.92, p<0.001
60
50
40
30
20
0
1.Owan et al. N Engl J Med 2006;355:251–9
2. Blanche et al. Swiss Med Wkly
2010;140:66–72
Increasing HFpEF prevalence
trends
11. In a retrospective study of 451 patients with HF in Sweden, time from diagnosis
to first post-diagnosis CV- or HF-related hospitalization was not significantly
different between HFpEF and HFrEF (p=0.49 and p=0.08, respectively)
Wikstrom et al. ESC 2011Gothenburg,
HFpEF & HFrEF: Similar initial hospital
rates
Time to first CV hospitalization Time to first HF hospitalization
1.00
0.75
0.50
0.25
0
0 200 800 1,000
400 600
Time (days)
Survival
distribution
function
1.00
0.75
0.50
0.25
0
0 200 8S
w
0e
0d
e
n
,
M
a
1y
,2
01
0–
2
04
,
2011
400 600
Time (days)
Survival
distribution
function
HFpEF (LVEF >45%)
HFrEF (LVEF ≤45%)
Wikstrom et al. ESC 2011 Gothenburg, Sweden, 21–24
May 2011
12. HFpEF survival rates are not
improving
• Owan et al. N Engl J Med
2006;355:251–9
Patients with HFpEF (LVEF≥50%)
Survival
1.0
0.8
0.6
0.4
0.2
0
0 1 2 3 4 5
Y
ear
p=0.36
1987–1991
1992–1996
1997–2001
Survival
1.0
0.8
0.6
0.4
0.2
0
Patients with HFrEF (LVEF<50%)
0 1 2 3 4 5
Y
ear
1987–1991
1992–1996
1997–2001
p=0.005
22. The diagnosis of HFrEF requires three conditions to be satisfied
1. Symptoms typical of HF
2. Signs typical of HF
3. Reduced LVEF
The diagnosis of HFpEF requires four conditions to be satisfied
1. Symptoms typical of HF
2. Signs typical of HF
3. Normal or only mildly reduced LVEF and LV not dilated
4. Relevant structural heart disease (LV hypertrophy/LA enlargement)
and/or diastolic dysfunction
McMurray et al. Eur Heart J 2012;33:1787–
847
The diagnosis of HFpEF is more difficult than the
diagnosis of HFrEF
Diagnosing
HF
24. There are many treatment objectives for
chronic HF
•
•
Dickstein et al. Eur Heart J 2008;29:2388–
442 McMurray et al. Eur Heart J
2012;33:1787–847
Objectives of treatment for chronic HF
1. Prognosis • reduce mortality
2. Morbidity • relieve symptoms and signs
• improve QoL
• eliminate edema and fluid retention
• increase exercise capacity
• reduce fatigue and breathlessness
• reduce the need for hospitalization
• provide end of life care
3. Prevention • occurrence of myocardial damage
• progression of myocardial damage
• remodelling of the myocardium
• reoccurrence of symptoms and fluid
accumulation
• hospitalization
25. Landmark trials in patients with
HFrEF
• Percentages are relative risk reductions vs
comparator
• 1.SOLVD Investigators. N Engl J Med
1991;325:293–302
2.CIBIS-II Investigators. Lancet 1999;353:9–
13; 3. Granger et al. Lancet 2003;362:772−6
4. McMurray et al. Lancet 2003;362:767–
771; 5. Swedberg et al. Lancet
2010;376:875–85
6. Zannad et al. N Engl J Med 2011;364:11–
21; 7. McMurray et al. N Engl J Med
2014;371:993–1004
CIBIS-II2 (1999)
2,647 patients
Key benefits of bisoprolol
(BB) vs placebo:
• 34% all-cause mortality
EMPHASIS-HF6 (2011)
2,737 patients
Key benefits of
eplerenone (MRA) vs
placebo:
• 37% CV mortality
or HF hospitalization
SHIFT5 (2010)
6,558patients
Key benefits of
ivabradine
(If inhibitor) vs placebo:
• 18% CV death or HF
hospitalizatio
n
PARADIGM-HF7
(2014)
8,442 patients
Key benefits of
LCZ696 (ARNI) vs
enalapril:
• 20% CV mortality
or HF
hospitalization
SOLVD-T1 (1991)
2,569 patients
Key benefits of enalapril
(ACEI) vs placebo:
• 16% all-cause mortality
CHARM-
Alternative3
(2003)
2,028 patients
Key benefits of
candesartan (ARB) vs
placebo:
• 23% CV mortality or
HF
hospitalizatio
n
CHARM-Added4 (2003)
2,548 patients
Key benefits of
candesartan
(ARB)vs placebo:
• 15% CV mortality or
HF hospitalization
1990
s
2000
s
2010
s
26. Chronic symptomatic systolic HF (NYHA II-IV)
– Step 1
McMurray et al. Eur Heart J 2012;33:1787–
847
Diuretics to relieve symptoms/signs of
congestion
+
ACE inhibitor (or ARB if not tolerated)
ADD a beta-
blocker Still
NYHA class
II-IV?
ADD an MR
antagonist
YE
S
N
O
No further specific treatment
Continue in disease-
management programme
Treatment options for
HFREF
27. Chronic symptomatic systolic HF (NYHA II-IV)
– Step 2
McMurray et al. Eur Heart J 2012;33:1787–
847
Still NYHA class II-
IV?
YE
S
N
O
LVEF ≤
35% ?
YE
S
N
O
SR and HR ≥ 70
beats/min
?
ADD
ivabradine
Still NYHA class
II-IV and LVEF ≤
35% ?
N
O
YE
S
No further specific treatment
Continue in disease-
management programme
Treatment options for
chronic HF
28. Chronic symptomatic systolic HF (NYHA II-IV)
– Step 3
Still NYHA class II-IV and LVEF
≤35% ?
YE
S
N
O
QRS duration ≥120
ms?
YE
S
N
O
Consider CRT-
P/CRT-D
Consider
ICD
Stil NYHA class II-
IV?
YES
Consider digoxin and/or H-ISDN
If end stage, consider LVAD and/or
transplantation
No further specific treatment
Continue in disease-
management programme
N
O
McMurray et al. Eur Heart J 2012;33:1787–
847
Treatment options for chronic
HF
29. Mortalityin HFrEF remains high despite the
introduction of therapiesthat improve
survival
•
•
1. McMurray et al. Eur Heart J 2012;33:1787–847;
2.SOLVD Investigators. N Engl J Med
1991;325:293–302; 3. CIBIS-II Investigators.
Lancet
1999;353:9–13; 4. Pitt et al. N Engl J Med
1999;341:709-17;
5. Granger et al. Lancet 2003;362:772–66. 6. Go et
al. Circulation 2014;129:e28-e292; 7. Yancy et al.
Circulation 2013;128:e240–327; 8. Levy et al. N
Engl J Med 2002;347:1397–402
*On top of standard therapy at the time of study (except in CHARM-Alternative where background ACEI therapy was excluded). Patient populations varied between trials and as such
relative risk reductions cannot be directly compared. SOLVD (Studies of Left Ventricular Dysfunction), CIBIS-II (Cardiac Insufficiency Bisoprolol Study II) and RALES (Randomized
Aldactone Evaluation Study) enrolled chronic HF patients with LVEF≤35%. CHARM-Alternative (Candesartan in Heart failure: Assessment of Reduction in Mortality and Morbidity)
enrolled chronic HF patients with LVEF≤40%
Survival rates in chronic HF have improved with the introduction of new therapies1
However, significant mortality remains – ~50% of patients die within 5 years of diagnosis6–8
16%
(4.5% ARR;
mean follow up
of 41.4
months)
SOLVD1,2
34%
(5.5% ARR;
mean follow up
of 1.3years)
CIBIS-II3
Reduction
in
relative
risk
of
mortality
vs
placebo
30%
(11.0% ARR;
mean
follow up of
24 months)
RALES4
17%
(3.0% ARR;
median follow up
of 33.7 months)
CHARM-
Alternative5
ACEI* β-blocker* MRA* ARB*
30. LCZ696 simultaneously inhibits neprilysin (via
LBQ657) and blocks AT1 receptors (via
valsartan)
•
•
Levin et al. N Engl J Med 1998;339:321–8
Nathisuwan & Talbert. Pharmacotherapy
2002;22:27–42 Schrier & Abraham. N Engl J Med
2009;341:577–85
Langenickel & Dole. Drug Discov Today: Ther Strateg
2012;9:e131–9
Feng et al. Tetrahedron Letters 2012;53:275–6
Inactive
fragments
ANP, BNP, CNP,
other
vasoactive
peptides*
1
AT receptor
Hypertrophy
Angiotensinoge
n (liver
secretion)
Ang
I
Ang
II
RAAS
LCZ6
96
Sacubitril
(AHU377; pro-
drug)
Inhibiting
Vasoconstriction
Blood pressure
Sympathetic tone
Aldosterone
Fibrosis
Enhancin
g
Vasorelaxation
Blood pressure
Sympathetic tone
Aldosterone levels
Fibrosis
Hypertrophy
Natriuresis/diuresis
LBQ657
(NEP inhibitor)
O
OH
HN
O
HO
O
Valsartan
N
N
N NH
N
O O
OH
31. PARADIGM-HF: Study
design
McMurray et al. Eur J Heart Fail
2013;15:1062–73 McMurray et al. Eur J Heart
Fail 2014;16:817–25 McMurray et al. N Engl J
Med 2014;371:993–1004
LCZ696
200 mg BID§
Randomizati
on
n=8442
2
Weeks
1–2
Weeks
2–4
Weeks
Single-blind
active run-in
period
Double-blind
Treatment
period
On top of standard HFrEF therapy (excluding ACEIs and ARBs)
Median of 27 months’
follow-up
LCZ696
100 mg
BID‡
Enalapril
10 mg
BID*
Enalapril 10 mg
BID#
LCZ696 200 mg
BID§
.
For more details on the PARADIGM-HF study, refer to the
dedicated slide kit
32. Primary endpoint: Death from CV
causes or first hospitalization for
HF
• McMurray et al. N Engl J Med 2014;371:993–
1004
Hazard ratio = 0.80 (95% CI: 0.73–
0.87) p<0.001
No at
risk
LCZ696 4,187 3,922 3,663 3,018 2,257 1,544 896 249
Enalapril 4,212 3,883 3,579 2,922 2,123 1,488 853 236
Cumulative
probability 1.
0
0.
6
0.
4
0.
2
0
0 18
0
36
0
540 720
Days since
randomization
90
0
1,08
0
1,26
0
Enalapr
il
LCZ696
33. Primary
outcome
*Calculated with the use of stratified cox proportional-hazard models; ‡Two-sided p-values calculated by means of a stratified log-rank test without adjustment for multiple
comparisons.
McMurray et al. N Engl J Med 2014;371:993–1004
Outcome, n %
LCZ696
(n=4,187)
Enalapril
(n=4,212)
Hazard ratio*
(95% CI) p value‡
Primary composite outcome
Death from CV causes or first
hospitalization for worsening of
HF
914 (21.8) 1,117 (26.5) 0.80 (0.73–0.87) <0.001
Death from CV causes 558 (13.3) 693 (16.5) 0.80 (0.71–
0.89)
<0.001
First hospitalization for
worsening of HF
537 (12.8) 658 (15.6) 0.79 (0.71–
0.89)
<0.001
The difference in favor of LCZ696 was seen early in the trial and at each interim
analysis
Over the duration of the trial, the numbers of patients who would need to have
been treated (NNT) to prevent:
• one primary event was 21 patients,and
• one death from CV causes was 32 patients
34. Prospectively defined safety
events
• McMurray et al. N Engl J Med 2014;371:993–
1004
Event, n (%)
LCZ696
(n=4,187)
Enalapril
(n=4,212) p value
Hypotension
Symptomatic 588 (14.0) 388 (9.2) <0.001
Symptomatic with SBP <90 mmHg 112 (2.7) 59 (1.4) <0.001
Elevated serum creatinine
≥2.5 mg/dL 139 (3.3) 188 (4.5) 0.007
≥3.0 mg/dL 63 (1.5) 83 (2.0) 0.10
Elevated serum potassium
>5.5 mmol/L 674 (16.1) 727 (17.3) 0.15
>6.0 mmol/L 181 (4.3) 236 (5.6) 0.007
Cough
Angioedema (adjudicated by a blinded expert committee)
474 (11.3) 601 (14.3) <0.001
No treatment or use of antihistamines only 10 (0.2) 5 (0.1) 0.19
Catecholamines or glucocorticoids without hospitalization 6 (0.1) 4 (0.1) 0.52
Hospitalized without airway
compromise Airway compromise
3 (0.1)
0
1 (<0.1)
0
0.31
---
• Fewer patients in the LCZ696 group than in the enalapril group stopped
theirstudy medication because of an AE (10.7 vs 12.3%, p=0.03)
35.
36. Patients with HFpEF may require novel
approaches to treatment
1.McMurray et al. Eur Heart J 2012;33:1787–
847
2. Blanche et al. Swiss Med Wkly
2010;140:66–72
HFrEF1
• Multiple, randomized
controlled, double-blinded,
clinical trials
• Therapeutic strategies based
on outcomes
• General consensus on
treatment
among the HF community
• Randomized controlled trials
have been supported by
observational data
• Evidence-based medicine
HFpEF1,2
• Mostly mechanistic studies
and small, non-definitive
trials
• Therapeutic strategies based
on symptoms and co-
morbidities
• Limited consensus on
treatment among the HF
community
• Disconnect between
randomized controlled trials
and observational data
• Anecdote-based medicine
37. There is a need for therapeutic
advances in patients with
HFpEF
Pre-
1980
198
5
199
0
199
5
200
0
200
5
201
0
201
5
CCB‡§
(verapamil
,
diltiazem)
Digoxin‡
Loop diuretics (e.g.
furosemide,
bumetanide)
Beta-
blocker‡
(bisoprolol)
There are few approved treatments recommended for the management of signs and
symptoms of HFpEF6*
While recent advances in the management of HFrEF have resulted in a
significant extension of life expectancy,1–5 this is not reflected in HFpEF6
No proven therapies exist for the treatment of HFpEF6 and little progress
has been made towards identifying a suitable treatment in the last 30 years
1. Dickstein et al. Eur Heart J 2008;29:2388–442; 2. SOLVD Investigators. N Engl
J Med 1991;325:293–302; 3. Granger et al. Lancet 2003;362:772–6; 4. Pitt et al. N
Engl J Med 2003;348:1309–21; 5. Zannad et al. N Engl J Med 2011;364:11–21; 6.
McMurray et al. Eur Heart J 2012;33:1787–847
42. Hallow KM et al. Diabetes Obes Metab. 2017 Oct 12. doi:
• SGLT2-i agent ↓ses IF volume by 2-fold greater than blood volume
• Loop diuretic ↓ses IF volume by only 78% of reduction in blood
volume
SGLT2-i agent
Effect
Loop Diuretic
Effect
Da
y
Da
y
Day
Da
y
50. SGLT-2i in
Established HF
• An Outcome Trifecta
• Reduces CV death
• Reduces hospitalizations for HF
• Improves symptom burden
• All with a favorable safety profile
51. Impact of SGLT2i CVOTs:
New Algorithm for Diabetes Treatment
based on CVD status
Rodriguez V, et al. J Clin Lipidol. 2017 Jul 22. pii: S1933-
2874(17)30389-6.
52. Ongoing Trials Will Look to Confirm CV Benefits in
Patients With HF
2018 2019 2020 2021 2022
1Q 2Q 3Q 4Q 1Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
Select
SGLT2i
HF
Trials
CV/HF
Outcomes
and/or
Biomarkers
2Q 3Q
DAPA-HF1
PRESERVED-HF7
EMPERIAL-Reduced8
HFrEF
DETERMINE-Reduced9
Exercise
Capacity
EMPERIAL-Preserved10
HFpEF
DETERMINE-Preserved11
HFrEF
HFpEF
EMPEROR-Reduced2
DEFINE-HF3
DELIVER5
EMPEROR-Preserved6
SOLOIST-WHF4
HFpEF=heart failure with preserved ejection fraction; HFrEF=heart failure with reduced ejection fraction.
1. ClinicalTrials.gov. DAPA-HF. NCT03036124.https://clinicaltrials.gov/ct2/show/record/NCT03036124. Accessed June 11, 2019. 2. ClinicalTrials.gov. EMPEROR-Reduced.NCT03057977.https://clinicaltrials.gov/ct2/show/NCT03057977.
Accessed June 11, 2019.
3. ClinicalTrials.gov. DEFINE-HF. NCT02653482. https://clinicaltrials.gov/ct2/show/NCT02653482. Accessed June 11, 2019. 4. ClinicalTrials.gov. SOLOIST-WHF. NCT03521934. https://clinicaltrials.gov/ct2/show/NCT03521934. Accessed June
24, 2019. 5. ClinicalTrials.gov. DELIVER. NCT03619213. https://clinicaltrials.gov/ct2/show/record/NCT03619213. Accessed June 11, 2019. 6. ClinicalTrials.gov. EMPEROR-Preserved. NCT03057951.
https://clinicaltrials.gov/ct2/show/NCT03057951. Accessed June 11, 2019. 7. ClinicalTrials.gov. PRESERVED-HF. NCT03030235. https://clinicaltrials.gov/ct2/show/NCT03030235. Accessed June 19, 2019. 8. ClinicalTrials.gov. EMPERIAL-
Reduced. NCT03448419. https://clinicaltrials.gov/ct2/show/record/NCT03448419. Accessed June 11, 2019. 9. ClinicalTrials.gov. DETERMINE-Reduced. NCT03877237. https://clinicaltrials.gov/ct2/show/NCT03877237. Accessed June 11,
2019.10. ClinicalTrials.gov. EMPERIAL-Preserved. NCT03448406. https://clinicaltrials.gov/ct2/show/record/NCT03448406. Accessed June 11, 2019.
11. ClinicalTrials.gov. DETERMINE-Preserved.NCT03877224.https://clinicaltrials.gov/ct2/show/NCT03877224. Accessed June 11, 2019
53. • SGLT-2i prevent symptomatic HF in high-risk patients
• SGLT-2i (dapagliflozin) reduce death, HF hospitalizations and
symptom burden in patients with established HFrEF
• Opens new era in HFrEF management – with new class of
disease-modifying agents
• Important implications for clinical practice and HF guidelines
• Efficacy in treatment of HFpEF remains to be established
SALIENT FEATURES OF SGLT2
INHIBITORS
54. Device Therapy for
HF
• Implantable cardioverter-
defibrillator
• Cardiac resynchronization therapy
• Mechanical Circulatory Support
• Cardiac Transplantation
55. Digoxin:
recommendation
• Digoxin can be beneficial in patients with
HFrEF, to decrease hospitalizations for HF
• treatment with digoxin for 1 to 3 months can
improve symptoms, HRQOL (Health Related
Quality of Life), and exercise tolerance in patients
with mild to moderate HF
• treatment with digoxin for 2 to 5 years had no
effect on mortality but modestly reduced the
combined risk of death and hospitalization
• Digoxin can be used only in patients who
remain symptomatic despite therapy with the
neurohormonal antagonists or in patients with
AF
56. Pulmonary Artery Pressure-Guided
Therapy for Ambulatory Heart Failure Patients
in Clinical Practice:
1-Year Outcomes from the CardioMEMS Post-Approval Study
David M. Shavelle MD1, Akshay S. Desai MD, William T.Abraham MD, Robert
C. Bourge MD, Nirav Raval MD, Lisa D. Rathman NP, J. Thomas J. Heywood
MD, Rita A. Jermyn MD, Jamie Pelzel MD, Orvar T.Jonsson MD, Maria Rosa
Costanzo MD, John D. Henderson, Sandra A. Carey PhD,
Philip B. Adamson MD and Lynne W. Stevenson MD
for the CardioMEMS PAS Investigators
1Division of Cardiology, University of Southern California, Los Angeles, CA
Registration: www.clinicaltrials.gov, NCT 02279888
57. BACKGROU
ND
1Abraham WT,et al. Lancet 2011:377:658-666.
• The burden of HF hospitalization (HFH) remains high despite
increasingly effective medical therapy
• Most HFH occur because of ‘congestion’ or elevated cardiac filling
pressures
• Increases in pulmonary artery (PA) pressures occur weeks in
advance of the signs and symptoms that prompt HFH
• Therapy guided by PApressures in the randomized CHAMPION
study1 resulted in a 37% reduction in HFH rates and all cause
hospitalization (ACH)
58. Sensor Home electronics unit
Systolic PAP
Mean PAP
Diastolic PAP
CardioMEMS-HF system: Ambulatory
Hemodynamic
Monitoring with an Implantable PAP
Sensor
Daily PAmeasurement
Database
PApressure trend data
59. Hospitalizations for HF
at 1 year
1.24
0.52
0.4
0.2
0
1-Year Pre Implant
0.8
0.6
1.2
1
1.4
HFH
Rate
(events/pt-yr)
1 Year Post-Implant
0.42 (0.38, 0.47)
p<0.0001
0.56 (0.51, 0.62)
p<0.0001
1.24
44%
0.69
0
0.2
0.4
0.6
0.8
1
1.2
1.4
HFH/Death
Rate
(events/pt-yr)
1-Year Pre Implant 1 YearPost-Implant
Hospitalizations for
HF/Death at
1 year
Hazard Ratio, 95% Confidence Interval and p-value estimated from the Anderson-Gill model.
All hospitalization events adjudicated by CEC.
58%
60. All Cause Hospitalizations at 1
year
0
1-Year Pre Implant
1 YearPost-Implant
2.25
0.72 (0.67, 0.77)
p<0.0001
28%
1.61
1.5
1
0.5
2
2.5
All
Cause
Hospitalization
(events/pt-yr)
Hazard Ratio, 95% Confidence Interval and p-value estimated from the Anderson-Gill model.
All hospitalization events adjudicated by CEC.
61. Survivor Analysis: Hospitalizations for HF
at 1 year, n=1009 (Survival 84%)
1.20
0.8
0.6
0.41
0.4
0.2
0.0
1-Year Pre Implant
1 YearPost-Implant
1.2
1.0
1.4
0.34 (0.30, 0.39)
p<0.0001
66%
HFH
Rate
(events/pt-yr)
Hazard Ratio, 95% Confidence Interval and p-value estimated from the Anderson-Gill model.
All hospitalization events adjudicated by CEC.
62. • In the commercial setting, PApressure-guided therapy for HF:
• Decreased PApressures
• Decreased HF Hospitalizations
• Across sex and race
• Across all EF ranges
• Amongst 1-year survivors
• Decreased All-Cause Hospitalization
• PApressure-guided therapy was safe with few device/system related
complications and a low rate of pressure sensor failure
CONCLUSIONS OF CHAMPION
TRIAL
64. An overview of the presented novel therapeutic methods
with respect to their mechanism of action and latest
stage of clinical development
Machaj et al,. New therapies for the treatment of heart failure: a summary of recent accomplishments.
65. Summary & Conclusions
• Prevalence of HF is fast assuming epidemic proportions
as evident by growing number of hospitalizations,
increased mortality & spiraling costs associated with it.
• Prognosis remains dismal as mortality is higher than
many malignancies.
• Diagnosis of HF is clinical but classification requires
ECHO assessment
• HFpEF comprises 50% of total HF cases
• Treatment of well established with
ACEi/ARB/ARNI,
HFrEF is
MRA, Beta blockers providing
substantial mortality benefit.
•
66. Contd..
• Specific therapy for HFpEF is still a distant dream & treating
co-morbid conditions remains only option.
• Device therapy like ICD, CRT & IHM are beneficial come at
expense of prohibitive cost.
• Newer drugs continue to evolve to combat the deadly
disease. Omecamtiv mecarbil, Vericiguat, Rolophylline,
Istaroxime are few examples.
• SGLT2 inhibitor is the new hope to millions of HF patients with
DM.
• A time may come when SGLT2 inhibitors will be routinely
used in HF patients irrespective of diabetic status.
