Heart Failure CE/CME ACCREDITED Watch Time: 35 mins

touchPANEL DISCUSSION Aiming for improved outcomes in HFrEF: Patient education, evidence-based treatment and biomarkers

Watch a panel of experts discuss strategies to support patients following a diagnosis of heart failure with reduced ejection fraction (HFrEF), implementing evidence-based therapies into clinical practice and the role of biomarkers in patient management.

Prof. Piotr Ponikowski

Wrocław Medical University, Wrocław, Poland

CHAIR

Panelists:
Prof. Adriaan Voors, Dr Stephen Greene
 
Video Chapters
Introduction

Prof. Piotr Ponikowski introduces the panel of leading experts in heart failure and outlines the agenda for discussion on patient support, evidence-based therapies and biomarkers in HFrEF.

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1/4 Next Chapter
 
How can we help patients navigate their journey after a diagnosis of HFrEF?

The panel discusses the patient journey with HFrEF, including key challenges, patient education and the potential impact of treatment changes on clinical outcomes.

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2/4 Next Chapter
 
How can we implement evidence-based therapies for HFrEF into clinical practice?

The panel considers the unmet needs in the management of HFrEF and reviews new treatment approaches.

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3/4 Next Chapter
 
What are the current and prospective roles of HFrEF biomarkers for guiding patient management?

The panel discusses the role of biomarkers for guiding decision-making in HFrEF.

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Learning Objectives & Overview
Overview

In this activity, a panel of experts discuss approaches for improving outcomes in patients with HFrEF. They consider key educational points for patients, selecting evidence-based therapies and using biomarkers to guide decision-making.

This activity is jointly provided by USF Health and touchIME.read more

Target Audience

This activity has been designed to meet the educational needs of cardiologists, primary care physicians and heart failure nurse specialists involved in the management of heart failure.

Disclosures

All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Piotr Ponikowski discloses: Advisory board or panel fees from: Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Impulse Dynamics, Merck Sharp & Dohme, Novartis and Vifor Pharma. Speaker’s bureau fees from: AstraZeneca, Boehringer Ingelheim, Impulse Dynamics, Novartis, and Vifor Pharma. Research grants from: Vifor Pharma.

Prof. Adriaan Voors discloses: Consulting fees and/or research grants from: Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cytokinetics, Myokardia, Merck, Novo Nordisk, Novartis and Roche Diagnostics.

Dr Stephen Greene discloses: Advisory board/consulting fees from: Amgen, AstraZeneca, Bayer, Cytokinetics, Merck and Vifor Pharma. Research support from: American Heart Association, Amgen, AstraZeneca, Bristol-Myers Squibb, Merck, Novartis and Pfizer.

Content Reviewer

Madjid Mirzai-Tehrane, MD has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Sola Neunie has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 Credit into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 Credit by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 09 August 2021. Date credits expire: 09 August 2022.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Describe approaches to support patients following a diagnosis of HFrEF
  • Use the latest data to select the most appropriate evidence-based treatment for each patient with HFrEF
  • Discuss the use of biomarkers to guide treatment selection and monitoring
Faculty & Disclosures
Prof. Piotr Ponikowski

Wrocław Medical University, Wrocław, Poland

Piotr Ponikowski is Professor of Cardiology, Rector and Head of Department of Heart Diseases at Wrocław Medical University. He is also Head of the Center for Heart Diseases at University Hospital, Wrocław, Poland. read more

His research interests focus on the pathophysiology and management of acute and chronic heart failure. He is a co-author of more than 700 peer-reviewed papers, with a total number of citations >95000 and an h-index of 117. Prof. Ponikowski has been recognized as a Highly Cited Researcher by Thomson Reuters in 2016, 2017, 2018 and 2019.

Prof. Ponikowski has served as a member of the Board of the European Society of Cardiology’s (ESC) Heart Failure Association (HFA). He served as President of the HFA from 2010–2012 and is the former president of the Polish Cardiac Society.

Prof. Ponikowski has been involved in the development of several guidelines on the management of cardiovascular diseases (edited by the ESC, as the member of the ESC Committee for Practice Guidelines) and was Chair of the 2016 ESC Heart Failure Guidelines.

Prof. Ponikowski is a member of editorial boards for several cardiology-focused journals. He has been a member of international steering/executive committees and endpoint committees for numerous clinical trials.

Prof. Piotr Ponikowski discloses: Advisory board or panel fees from: Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Impulse Dynamics, Merck Sharp & Dohme, Novartis and Vifor Pharma. Speaker’s bureau fees from: AstraZeneca, Boehringer Ingelheim, Impulse Dynamics, Novartis, and Vifor Pharma. Research grants from: Vifor Pharma.

Prof. Adriaan Voors

University Medical Center Groningen, Groningen, The Netherlands

Adriaan Voors is Professor of Cardiology and specializes in heart failure at the University Medical Centre Groningen, The Netherlands. read more

Prof. Voors has been Established Clinical Investigator of the Netherlands Heart Foundation since 2007 and is currently Director of the Heart Failure Clinic of the Department of Cardiology at the University Medical Center Groningen.

Prof. Voors has supervised 40 PhD students, mainly on heart failure-related topics. He is an editorial board member of the European Journal of Heart Failure, Clinical Research in Cardiology, Cardiovascular Drugs and Therapy, the Journal of Cardiovascular Medicine and Heart Failure Reviews. He has been involved in 49 clinical trials for novel therapies in acute and chronic heart failure, as either the principal investigator or an executive/steering committee member.

Prof. Voors was a member of the 2012 ESC Heart Failure Guidelines Committee, and Co-Chair of the 2016 ESC Heart Failure Guidelines. He has authored 640 peer-reviewed papers and several books and chapters. His h-index is 90.

Prof. Adriaan Voors discloses: Consulting fees and/or research grants from: Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cytokinetics, Myokardia, Merck, Novo Nordisk, Novartis and Roche Diagnostics.

Dr Stephen Greene

Duke University, Durham, NC, USA

Stephen Greene is a cardiologist and Assistant Professor of Medicine in the Division of Cardiology and Duke Clinical Research Institute, at the Duke University School of Medicine. read more

Dr Greene specializes in caring for patients with heart failure, including patients who are best treated with medications and patients who receive advanced therapies, including left ventricular assist devices and heart transplants.

Dr Greene’s research focuses on improving quality of care and outcomes for patients with heart failure. He has been a collaborator and co-author of multiple national and international heart failure trials, including the ASTRONAUT, SOCRATES-Reduced and COMPOSE trials, as well as the ongoing TRANSFORM-HF trial. He has led multiple analyses from national registries, characterizing the quality of heart failure treatment in routine clinical practice, including studies leveraging the American Heart Association’s Get With The Guidelines Heart Failure registry, the CHAMP-HF registry and the VICTORIA registry.

Dr Greene’s collaborative work has led to more than 185 publications in peer-reviewed journals.

Dr Stephen Greene discloses: Advisory board/consulting fees from: Amgen, AstraZeneca, Bayer, Cytokinetics, Merck and Vifor Pharma. Research support from: American Heart Association, Amgen, AstraZeneca, Bristol-Myers Squibb, Merck, Novartis and Pfizer.

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Question 1/4
Your patient is a 56-year-old man with newly confirmed HFrEF. He has a LVEF of 28% and his symptoms are classified as NYHA Class III. You have just informed him of his diagnosis. What immediate advice will you provide?

HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association.
Correct

Following the diagnosis of HFrEF, patients should be given comprehensive education and counselling around their disease, including disease-related factors that are individualized to their case. Advice should be provided on adjusting to prescribed therapies, specific signs and symptoms associated with the disease, the importance of medication adherence and suggested healthy lifestyle changes (such as a high fibre diet, regular exercise in a tolerable amount, consuming alcohol in moderation and no smoking).

HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association.

Reference

Inamdar AA, Inamdar AC. J Clin Med. 2016;5:62.

 

Question 2/4
What is the rationale behind the newly proposed rapid sequencing regimen for HFrEF, whereby patients are prescribed four therapies (ARNI/ACEI, beta-blocker, MRA and SGLT2i) simultaneously or within 4 weeks versus conventional sequencing, whereby patients are prescribed therapies incrementally over the course of several months?

ACEI, angiotensin-converting enzyme inhibitor; ARNI, angiotensin receptor neprilysin inhibitor; HFrEF, heart failure with reduced ejection fraction; MRA, mineralocorticoid receptor antagonist; SGLT2i, sodium-glucose cotransporter 2 inhibitor.
Correct

A rapid sequencing strategy has been proposed based on the rationale that, since all four drugs act rapidly to reduce morbidity and mortality, patients should be started on all four foundational treatments simultaneously or within 2–4 weeks.1,2 In addition, the efficacy of each drug is independent and incremental to the other drugs. This further supports the goal of simultaneous use of all four drugs as quickly as possible, rather than delaying initiation of a newer therapy for purposes of increasing the dose of a therapy already prescribed.1,2

ACEI, angiotensin-converting enzyme inhibitor; ARNI, angiotensin receptor neprilysin inhibitor; HFrEF, heart failure with reduced ejection fraction; MRA, mineralocorticoid receptor antagonist; SGLT2i, sodium-glucose cotransporter 2 inhibitor.

References

  1. Packer M, McMurray JJV. Eur J Heart Fail. 2021. doi: 10.1002/ejhf.2149. Epub ahead of print.
  2. Greene SJ, et al. JAMA Cardiol. 2021;6:743–4.
Question 3/4
Your patient is a 62-year-old male who you suspect has HFrEF. Which of the following biomarkers should you test for to help confirm a diagnosis?

BNP, brain-type natriuretic peptide; HFrEF, heart failure with reduced ejection fraction; IL-6, interleukin 6; NT-proBNP, N-terminal prohormone of brain-type natriuretic peptide; TNF-α, tumour necrosis factor alpha.
Correct

BNP is secreted in response to increased ventricular stretching. BNP has a short half-life of 20 minutes when compared with NT-proBNP, which has a circulation half-life of 60–120 minutes.1

Higher concentrations of BNP or NT-proBNP in an ambulatory patient with HFrEF inform high risk, particularly when the concentrations are rising.2 Current guidelines recommend the measurement of BNP or NT-proBNP to support a clinical diagnosis of HF, assess disease severity or establish prognosis.3

BNP, brain-type natriuretic peptide; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; NT-proBNP, N-terminal prohormone of brain-type natriuretic peptide.

References

  1. Shrivastava A, et al. Front Cardiovasc Med. 2020;7:601364.
  2. Maddox TM, et al. J Am Coll Cardiol. 2021;77:772–810.
  3. Yancy CW, et al. Circulation. 2017;136:e137–61.
Question 4/4
What does the latest evidence suggest with respect to the use of biomarkers for guiding treatment decisions in patients with HFrEF?

HFrEF, heart failure with reduced ejection fraction.
Correct

Natriuretic peptides are well established in clinical practice for the diagnosis and prognostication of HFrEF.1 Current ACC clinical practice guidelines give a Class I recommendation to measure BNP or NT-proBNP to support a clinical diagnosis of HF, assess disease severity or establish prognosis.2 However, these guidelines state that there are insufficient data to inform specific recommendations related to natriuretic peptide (BNP or NT-proBNP) guided therapy.2

ACC, American College of Cardiology; BNP, brain-type natriuretic peptide; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; NT-proBNP, N-terminal prohormone of BNP.

References

  1. Maddox TM, et al. J Am Coll Cardiol. 2021;77:772–810.
  2. Yancy CW, et al. Circulation. 2017;136:e137–61.
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