This article features the top 5 stories in Practical Cardiology's coverage of heart failure in 2020.
As part of our Year in Review series, Practical Cardiology’s editorial staff has put together a curated list made up of the most viewed and clinically impactful stories from various subspecialties in cardiology.
For cardiologists, 2020 was a year dominated by coronavirus disease 2019 (COVID-19) and many cardiologists were asked to do more than ever before. Even in the face of the worst pandemic in a century, the field continued to make advances in care and research. The following list is a collection of the most popular and most impactful stories in heart failure from the last year.
While most expected this approval given the substantial clinical data provided by DAPA-HF and numerous other studies, the approval of dapagliflozin (Farxiga) remains one of, if not, the most significant FDA approvals in heart failure in decades. Long considered a class of antiglycemic agents with a modest effect on HbA1c and weight loss, the role of SGLT2 inhibitors has been transformed.
Presented at ESC 2019, the 4744-patient DAPA-HF trial provided enough evidence to support the approval of dapagliflozin for reducing the risk of cardiovascular death and hospitalization for heart failure in patients with heart failure with reduced ejection fraction (HFrEF), regardless of diabetes status.
Excitement continued to build around the potential for sacubitril/valsartan (Entresto) in the treatment of patients with heart failure with preserved ejection fraction (HFpEF) during 2020. In recent years, studies such as PARAGON-HF and PARALLAX have examined the effects of the therapy on HFpEF biomarkers.
While no approval for HFpEF came in 2020, the US FDA’s Cardiovascular and Renal Drugs Advisory Committee voted 12 to 1 in favor of an indication for sacubitril/valsartan after a review of data from the PARAGON-HF trial.
If it were even possible, researchers provided even more for clinicians to be excited about from SGLT2 inhibitors at AHA 2020. This time it came from sotagliflozin a dual SGLT2/1 inhibitor, which were the subject of the phase 3 SCORED and SOLOIST-WHF trials.
Developed for use in type 1 and type 2 diabetes, sotagliflozin demonstrated benefit in populations of patients with worsening heart failure and chronic kidney disease. This article features an 8-minute video with Bhatt and links to full-length articles detailing the result of the landmark trials.
After the results of DAPA-HF and approval of dapagliflozin, many expected to see similar effects on heart failure from empagliflozin (Jardiance) in the phase 3 EMPEROR-Reduced trial. Presented at the European Society of Cardiology Congress 2020, the trial examined the effects of empagliflozin in more than 3700 patients with HFrEF.
Results of the study suggested use of empagliflozin reduced the risk of serious heart failure events by 30% and decreased the risk of serious adverse renal outcomes by 50% and this effect was seen in populations of patients both with and without type 2 diabetes.
After positive results in phase 2 COSMIC-HF, cardiologists grew excited at the prospect of another therapy that could revolutionize treatment of HFrEF. Clinicians hoped the novel selective cardiac myosin activator omecamtiv mecarbil could improve cardiac function of HFrEF patients.
At AHA 2020, clinicians were given further insight into the effects of omecamtiv mecarbil from the phase 3 GALACTIC-HF trial. Results of the trial results indicated omecamtiv mecarbil was associated with reductions in first heart failure event, but not cardiovascular death when compared to placebo therapy.