American Heart Association

Octreotide may prevent recurrent GI bleeds in CF-LVAD patients

Contributor: Nick Hawkes

CF-LVAD patients experience high rates of gastrointestinal (GI) bleeding. A multicenter, retrospective analysis by Shah et al demonstrated that patients with a prior GI bleed after CF-LVAD implantation had a lower rate (24% vs 43%) of recurrent GI bleed when receiving octreotide.

Fifty-one patients were identified from 5 participating centers. All patients had one previous GI bleed following CF-LVAD implantation, and received octreotide treatment for at least 6 months following index GI bleed. Octreotide was dosed as a monthly depot injection in 72% of patients or twice daily subcutaneous injection in 28%. Shah et al used a comparison group of HMII CF-LVAD patients who had experienced a GI bleed in clinical trials using HMII bridge-to-transplant (BTT) and destination therapy (DT). Patients were propensity matched based on HF etiology, CF-LVAD indication, CF-LVAD support time, sex, and age. Of the 51 CF-LVAD patients analyzed, 50% were DT. Twelve patients (24%) who received octreotide experienced a recurrent bleed vs 22 (43%) of the comparison group (p<0.04).

Sacubitril/Valsartan improves quality of life in patients with HFrEF

Contributor: Nicholas Hawkes

Quality not quantity. Why not both? It is established that sacubitril/valsartan is superior to enalapril (or dose-equivalent ACE-I) when it comes to mortality and morbidity in HFrEF. But what about quality of life (QoL)? Patients enrolled in PARADIGM-HF had increased quality of life when randomized to sacubitril/valsartan.

The more the merrier? Dose of ACE-I/ARBs and outcomes in HFrEF

Contributor: Steven Stroud

It is reported that more is more for HFrEF patients and angiotensin converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) therapy. In a recent meta-analysis of six randomized trials*, higher doses of ACE-I/ARBs were associated with a reduction in all-cause mortality. Of note, when the ARB trial (HEAAL) was taken out of the analysis, higher dose ACE-I alone did not reach statistical significance.

Ivabradine: Valuable in HFrEF for a select few

Contributor: Mat Bull

Less is more when it comes to heart rate in HF. Ivabradine, a sinus node inhibitor, lowers heart rate, thereby decreasing myocardial demand. Some beta blockers have mortality benefit in HFrEF as shown by the MERIT-HF and COPERNICUS trials, and a side effect of these drugs is heart rate lowering. Thus, beta-blockers are standard of care in HFrEF; however, at maximally indicated doses, undesired side effects often occur. Since ivabradine targets very specific ion channels within the SA node, further heart rate reduction is possible. But which patients are eligible for this therapy? Read on.