New research was presented at HFSA 2021, the Heart Failure Society of America Annual Scientific Meeting 2021, held September 10-13 in Denver and virtually. The features below highlight some of the studies that HFSA2021emerged from the conference.
Similar Benefits in Black & White Patients With HF Agent
With limited data on the impact of HF medications in non-White patients, researchers conducted an analysis of the GALACTIC-HF trial to assess active therapy with omecamtiv mecarbil among Black and White patients with HF with reduced ejection fraction (HFrEF). Eligible participants had a New York Heart Association classification of 2-4, with a left ventricular EF no higher than 35% on such therapy and prior hospitalization for HF or an HF event—defined as an HF hospitalization or emergency room/ urgent care visit for escalation of therapy—in the preceding year. The researchers randomly assigned 562 Black patients to omecamtiv mecarbil or placebo. Active therapy correlated with an HR of 0.82 (95% CI, 0.64-1.04) for the primary endpoint of cardiovascular death or HF event. Although the risk reduction didn’t reach significance, it represented 7.7 events prevented per 100 patient-years, for a number needed to treat of 13. The effect appeared to be mainly related to HF events (HR, 0.82); the HRs for HF hospitalization alone and CV death were 0.80 and 1.03, respectively.
Lifestyle Intervention Improves Quality of Life in Patients With HF & Diabetes
A lifestyle intervention that included a step counter and regular, personalized text messages to encourage greater movement and medication adherence resulted in a considerable increase in quality of life (QOL) among 187 patients with any kind of HF and any kind of diabetes. In the TARGET-HF-DM study, conducted at six US sites, adults wore a step counter on their wrists and were randomly assigned to an intervention arm, with text messages three times per week that provided personalized feedback on recent activity and adherence and updated activity and adherence goals, or to a control group, which received a once-weekly generic reminder to wear the step counter. After 3 months, patients in the intervention arm had an average incremental gain from baseline of 313 steps per day compared with the controls, representing a significant difference for the study’s primary endpoint. A secondary analysis that used the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score to examine QOL demonstrated a 5.5-point average increased improvement after 3 months among patients in the intervention arm compared with controls. Score increases of 5 of more points on the KCCQ represent clinically meaningful changes, according to the study results. The researchers noted that because the study was not blinded, changes in QOL could be partially explained by patients feeling more engaged about working on their health.
Food Insecurity Linked With HF Rates
Previous studies indicate that increased food insecurity is independently linked with higher HF in the US. To dig deeper into the connection, investigators conducted a county-level analysis that compared HF mortality with socioeconomic data and markers of food security in addition to the Food Environmental Index (FEI), a metric that examines geographic and economic limitations on healthy food access on a scale of 1-10. The FEI was significantly and inversely related to HF mortality in the US. An analysis at the state level showed the greatest levels of food insecurity in the Southern US and higher food indexes in the West and Northeast. Counties with the highest HF mortality rates also had, per capita, the fewest grocery stores and food stores participating in government food assistance initiatives and the highest percentage of seniors with low access to food stores. Counties with lower-than-average FEI scores had more people whose race was not White, who had obesity or diabetes, and who lacked medical insurance. These counties also, on average, had fewer primary care physicians per capita when compared with other counties (65.4 vs 70.4 per 100,000).
Angiotensin Receptor-Neprilysin Inhibition Protects Brain
Patients with HF taking angiotensin receptorneprilysin inhibition (ARNI) therapy for several years demonstrated no excess rates of cognitive decline, according to an observational analysis for which EHR data was collected from the Tri NetX network across 46 US sites and investigators created 19,553 matched pairs with an average age of 63. Instead, the treatment was linked with a protective effect on the brain. Adults with systolic HF who began taking sacubitril/valsartan from 2015-2019 had a significantly lower rate of neurocognitive diagnoses up to 5 years later compared with a propensity-matched cohort of peers on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers alone (Alzheimer’s disease, 1.11% vs 1.24% [HR, 0.63]; dementia, 4.18% vs 6.49% [HR, 0.70]; and cognitive decline, 11.82% vs 14.53% [HR, 0.82]). The link between ARNI therapy and decreased neurocognitive events applied to both men and women, as well as Black and White patients.
Role Debated of Invasive Biopsies After Heart Transplant
Despite improvements in non-invasive alternatives, endomyocardial biopsies (EMB)—the current gold standard for routine surveillance of heart transplant rejection—remain valuable, according to researchers who participate in a debate at HFSA 2021. The clinicians discussed the safety of screening strategies and the justification for performing them, including the potential for life-threatening complications, such as tamponade and cardiac perforation with EMB and their limited diagnostic yield given the very low rate of asymptomatic rejection after heart transplantation, which is 1%-3% in contemporary practice. They also raised patient considerations related to EMB, such as anxiety and discomfort, and the value of the information derived from the procedure. However, the debate participants also noted clinical scenarios in which biopsies remain valuable and that newer, noninvasive tests, such as donor-derived cell-free DNA, are still being tested.
