American Heart Association

Low Adoption Rates of Sacubitril/Valsartan Use in the US

Contributor: Nick Hawkes

Sacubitril/valsartan reduces morbidity and mortality in patients with HFrEF, so why has the adoption of this therapy in the outpatient setting been so slow?

Clinical and In Vitro Evidence that LVAD-Induced Von Willebrand Factor Degradation May Alter Angiogenesis

Contributor: Darien Allen

GI bleeds in continuous-flow left ventricular assist device (CF-LVAD) patients are an increasing problem. Bartoli et al posit a two-hit hypothesis to explain the increased risk of mucosal bleeds in this population:

Hit 1: CF-LVAD-induced shear stress activates von Willebrand factor (VWF) multimers leading to enzymatic and mechanical degradation into variably sized fragments and acquired VWF deficiency. CF-LVAD induced VWF deficiency reduces VWF-collagen and VWF-platelet binding resulting in increased risk of mucosal bleeding.
Hit 2: Higher circulating concentrations of VWF fragments lead to altered angiogenesis and likely contribute to the development of angiodysplasia.

Oxidative state of cGMP-dependent protein kinase determines the efficacy of sildenafil vs direct guanylate cyclase activators in pressure-overload HF

Contributor: Elise Vo

Precision therapy for HF is on the horizon. Activating cyclic guanosine monophosphate (cGMP)-dependent protein kinase-1α (PKG1α), results in vasodilation and prevents cardiac remodeling — a good thing. There are two ways to activate PKG1a: 1) directly soluble guanylate cyclase (sGC) activators and 2) indirectly by PDE5 inhibition. So, do these two methods of targeting PKG1α work equally well? Nakamura et al used a TAC murine model to demonstrate that the oxidative state of PKG1α determines whether or not sildenafil is efficacious in preventing pathologic remodeling in pressure-overload HF.

Slow Adoption and Low Adherence of Sacubitril/Valsartan for HFrEF

Contributor: Nick Hawkes

PARADIGM – HF demonstrated that Sacubitril/Valsartan reduces morbidity and mortality in patients with HFrEF compared to ACE-I/ARB therapy, so why is its adoption in the real world delayed?

Sangaralingham et al. accessed data from OptumLabs Data Warehouse, a large database of de-identified medical and pharmacy claims. Among patients identified based on systolic HF ICD codes, those prescribed sacubitril/valsartan were compared to those who were not. Patient variables included health plan, age, gender, race, region, comorbidities, other prescription medications, and provider specialty. Additionally the costs, out-of-pocket (OOP) and to the health plan, were captured.

HF patient death leads to poor spousal outcomes

Contributor: Elise Vo

Being the spouse of a HF patient is challenging. In a recent study, Dunlay and colleagues explored the link between spousal health and HF patient outcomes. Interestingly, spousal health did not correlate with HF patient death or hospitalization. However, spouse caregivers experienced worse outcomes following the death of their HF partner.

Olmsted County residents were screened for HF between 2002-2012 using ICD-9 codes. 905 patients met study criteria, 586 (65%) males with mean age of 73.3, 96% Caucasian, and average LVEF 47.7%. The spousal characteristics were: 584 (65%) female, mean age of 71, and 96% Caucasian. HF patient charts were reviewed for marriage.