Heart failure: the new treatment for the most common heart disease in the world

Heart failure is considered a very common heart disease that includes several symptoms - which sometimes makes it difficult to detect.

Two recent studies conducted on a new drug found hopeful findings for patients

Dr. Avishai Gruper

11/09/2022

Sunday, September 11, 2022, 1:09 p.m. Updated: 1:25 p.m.

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Heart failure is considered the most common heart disease in the world.

According to estimates, tens of millions of people suffer from heart failure and its prevalence in the adult population in the Western world is estimated at 1 to 2 percent.

In Israel there are tens of thousands of people with heart failure - some are diagnosed and some are not.

Heart failure is not a single disease but a clinical manifestation that includes several types of diseases.

In fact, we define heart failure as a medical condition in which the heart fails to supply the amount of blood that the body needs.

This syndrome can be caused by a structural problem or a functional problem in the heart muscle.

The symptoms of heart failure are not specific and unique to the disease.

When these appear, they may raise the suspicion of heart failure - but they alone are not enough to establish a diagnosis.

The most common symptom is shortness of breath on exertion but of course there can be other reasons that cause this.

There are other symptoms such as fatigue, weakness, dizziness, palpitations, edema, swelling in the legs and abdomen, chest pains, etc., but as mentioned, these are also not specific to heart failure, so sometimes there is difficulty in diagnosing the disease.

There are other tests that can confirm or rule out heart failure - starting with a medical questioning of the patient, through a physical examination, blood tests and of course an imaging test "echo echocardiography" that gives the doctor a snapshot of the structure and function of the heart.

Today there is a specific blood test that can help confirm or rule out heart failure called "BNP".

The test checks the level of protein secreted by the heart muscle cells when they are in distress, therefore the higher the level of BNP measured in the blood, the greater the distress of the heart and it can be determined that the patient is suffering from heart failure.

This test is widely used in the world, but unfortunately it is not yet in the health basket in Israel and is only available in some hospitals in Israel.

Heart failure is not a single disease but a clinical manifestation that includes several types of diseases.

A man holding a heart (Photo: ShutterStock)

Although heart failure is a syndrome that includes a large number of diseases, patients can be divided into 3 main types based on an index known as "ejection segment" - an index that tests the ability of the heart muscle to contract.

The first type - "patients with heart failure and poor heart function" - these are patients whose ejection fraction is below 40 percent.

This group constitutes about half of the number of patients;

The second type - "patients with heart failure and preserved heart function" - these are patients whose ejection fraction is 50% or higher;

The third type - "patients with heart failure and mildly poor heart function" - these are patients whose ejection fraction is between 40 and 50 percent.

For patients with heart failure and poor function below 40 percent, there are currently several treatment options with drugs that have demonstrated a significant reduction in the main complications of the disease, such as a reduction in hospitalizations and cardiovascular mortality.

However, for the other two groups, all the drugs available for many years failed to prove a statistically significant improvement in the course of the disease, so the main treatment was focused on trying to improve the patient's symptoms.

"A real revolution"

Recently, a new study (DELIVER study) was published at the European Society of Cardiology ESC conference in Barcelona.

The study examined the effect of treatment with the drug "Forsiga" (dapagliflozin) on the group of patients with heart failure and preserved heart function and patients with heart failure and mildly poor heart function.

In fact, the study looked at the group of patients whose heart function is 40% or higher.

The study found that the drug succeeds in reducing the complications of the disease (hospitalizations and cardiovascular mortality in a combined result) and especially a significant reduction in the number of hospitalizations as a result of heart failure.

This is significant news because until last year, as mentioned, we had no treatments for this group of patients, and mainly because these patients suffer from repeated hospital admissions following the worsening of the disease.

"Forcega" belongs to a group of drugs called SGLT2 inhibitors.

The findings of the current study join a similar study of another drug from the same family that presented similar data about a year ago.

The fact that there is another independent study on the same group of patients that reinforces the findings is very important for the medical community and it confirms and reinforces the need for SGLT2 inhibitor treatment in this group of patients.

In addition, in a study published last year, the concern arose that as the heart's function increases, the drug's effectiveness decreases.

However, in the current study it became clear that the results of the effect of the drug treatment were uniform and significant in all patients regardless of the percentage of heart function.

In another study published at the conference last week, a combination was made of all patients with heart failure who received the drug "Forsiga" - both those with heart function of 40 percent or less (DAPA HF study from 2019) and those with heart function of 40 percent or more (DELIVER study from 2022).

The researchers did a new statistical analysis that included the entire patient population regardless of their heart function level.

In the study, 11,000 patients were examined and it was found that the drug "Forsiga" significantly reduced the hospitalizations from heart failure and also the mortality of these patients - regardless of the level of their heart function, and in fact this is the first study that demonstrated a reduction in mortality for all types of patients with heart failure.

These findings reinforce and attack the importance of treating patients with heart failure of all types.

SGLT2 inhibitor drugs started as drugs for diabetics and to this day do not fully know how the mechanism of these drugs works.

Many still mistakenly believe that these are only medicines for diabetes, but in fact these treatments have proven effective in protecting the heart and kidneys even in patients who do not have diabetes at all.

The findings of these studies constitute a real revolution.

Until now we had to do an echocardiogram in order to evaluate the heart's function in order to adjust the treatment according to the smoothness to the different groups of heart failure, and in fact from now on SGLT2 type drugs can provide a good therapeutic response for all heart failure patients and it doesn't matter what the percentage of their heart function is .

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