Worsening Heart Failure | Episode Two

From Lab to Life

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Host:

• Robert Underwood, MD
  • Emergency Physician

Guest:

• Erin D. Michos, MD, MHS
  • Director of Women’s Cardiovascular Health Research
  • Associate Director of Preventive Cardiology at Johns Hopkins University
  • Co-Director of the IMPACT Center at Johns Hopkins University
  • Co-Editor-in-Chief of the American Journal of Preventive Cardiology

Supported by:

• Independent educational grant from Merck, Sharp, and Dohme

Episode Overview:
In this episode, Dr. Robert Underwood and Dr. Erin Michos explore innovative strategies and cutting-edge therapies for managing worsening heart failure, focusing on novel treatment approaches, emerging medical devices, and advancements in the use of monitoring technology.

Key Takeaways:

• Edema in Worsening Heart Failure:
  • Edema is a key sign of worsening heart failure, driven by the overstimulation of the renin-angiotensin-aldosterone system (RAS) and sympathetic nervous system, leading to sodium and water retention.
  • As heart failure progresses, natriuretic peptides become less effective, causing more fluid retention and adverse remodeling of the heart, vasculature, and kidneys.
• Role of Diuretics:
  • Diuretics are the cornerstone for managing edema in heart failure. Though not class 1 indicated for heart failure itself, they are essential for decongestion and preventing hospitalization.
  • Commonly used loop diuretics include furosemide and torsemide, but electrolyte imbalances like hypokalemia must be monitored.
• Soluble Guanylate Cyclase (sGC) in Heart Failure Treatment:
  • sGC stimulators like vericiguat help regulate vascular tone, cardiac remodeling, and contractility by enhancing the production of cyclic GMP, which promotes vasodilation and reduces fibrosis.
  • Vericiguat, a first-in-class sGC stimulator, was approved after the VICTORIA trial and is used for patients with chronic heart failure and an ejection fraction <45%.
• The VICTORIA Trial:
  • The VICTORIA trial demonstrated that vericiguat significantly reduced hospitalizations and cardiovascular events in patients with worsening heart failure, with a favorable safety profile and similar adverse events between treatment groups.
• Monitoring Devices for Heart Failure:
  • Implantable Devices: These devices monitor pulmonary artery pressure and provide early detection of worsening symptoms. Though promising, further studies are needed, and current guidelines provide a class 2B recommendation for select patients.
  • Wearable Devices: Wearables like those that measure thoracic fluid index are gaining traction as non-invasive tools to detect heart failure deterioration early. Initial studies suggest a reduction in hospitalizations, but more research is needed.
• Future of Monitoring and AI Integration:
  • As wearable technology and smart devices evolve, there is growing potential for AI to process the massive amounts of data generated, turning it into actionable insights to help manage heart failure and improve patient outcomes.

Next Episode Teaser:
In the next episode, the panel will explore more advanced heart failure treatments and discuss the future role of AI in heart failure management.

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