Different aspects of pharmacological heart failure treatment

The effect of initiating sacubitril/valsartan (sac/val) therapy during hospitalization for acute heart failure (AHF) on left ventricular (LV) remodelling remains unclear.Dr Tanaka and co-workers from Japan, aimed to assess the impact of Sac/Val on LV remodelling in patients in whom sacubitril/valsartan (Sac/Val) was initiated during AHF hospitalization.The authors used data from Program of Angiotensin-Neprilysin Inhibition in Admitted Patients with Worsening Heart Failure (PREMIER) study, which investigated the impact of initiating Sac/Val during hospitalization for AHF on echocardiographic parameters over an 8-week period, in comparison with the standard renin-angiotensin system inhibitor therapy. 1 The study group concluded that in patients stabilized after hospitalization for AHF, Sac/Val may significantly improve some functional and structural parameters of the left ventricle, particularly in those with an LVEF < 40%, supporting its role as an effective therapy for reverse remodelling.Quality of life is an important issue in patients with HF. 2 Dr McMurray et al., present data on Sacubitril/valsartan and Quality of Life Assessed Using the EuroQol 5-Dimension 3-Level Questionnaire Level Sum Score in patients with HFrEF and HFmrEF/HFpEF.Changes in LSS severity at 8 months were analysed using ordinal logistic regression models to estimate the relative effect of sacubitril/valsartan vs. enalapril or valsartan.The authors concluded that sacubitril/valsartan significantly reduced the risk of heart failure (HF) events and improved health status across the LSS spectrum in HFrEF and HFpEF patients treated with enalapril or valsartan.While the beneficial effect of beta-blocker (BB) therapy for acute coronary syndrome (ACS) patients with left ventricular ejection fraction (LVEF) < 40% is established, its role in those with LVEF >40% is controversial. 3,4Dr Maeder and colleagues from Switzerland, assessed the relationship between BB therapy at discharge and 1-year mortality according to LVEF in a large contemporary ACS cohort (n = 7820).The authors found that among patients with LVEF 40%, mortality was lower in patients with BB compared to those without (5.9% vs. 14%; P < 0.001).In contrast, in patients with LVEF >40%, mortality did not differ between patients with and without BB (2.1% vs. 2.6%; P = 0.3).A statistically significant interaction between BB therapy and LVEF stratum was identified.