HF Disease State
This is the lifetime risk of HF at 40 years
What is 20%
What are 3 challenges to defining HFpEF?
What are
-no single test definitively diagnoses
-echo lacks pathognomonic features
-natriuretic peptides may be normal esp w/ obesity
3 of the 5 main differences between Finerenone & Spiro (as seen in FINEARTS-HF Trial)?
(what's the 'so what')
What are
-Improved Selectivity for the MR
-Short Half-Life (fewer long-lasting a/e)
-minimal hormonal adverse effects (avoids endocrine related a/e)
-balanced distribution in heart and kidney (leads to cardio-renal benefits)
-reduced risk of hyperkalemia (big safety advantage)
What is TOPCAT
These GLP1s are indicated for HFpEF & can be used when...
What is none.
-obesity
-overweight w at least 1 weight related comorbidity (htn, T2D/pre-D, Dyslipidemia)
In the USA HFpEF accounts for this amount in HF
What is greater than 50%?
The 3 scoring system algorithms for HFpEF
What are
-H2FPEF
-HFpEF-ABA
-HFA-PEFF
The 3 components of Finerenone’s indication in HFpEF?
What are
-Reduce risk of CV death
-Reduce risk of HHF
-Reduce urgent HF visits
These are the 3 main findings from TOPCAT
What are
-No significant benefit in CV Death or HHF
-Secondary benefit in HF Hospitalization
-Regional Differences between Russia/Georgia and N America
What are those w/ BMI ≥30
This Consensus Document is most appropriate for this patient setting
What is Ambulatory
The 6 readily accessible components of H2FPEF
What are -H2: Heavy 2 pts
on ≥2 antihypertensives 1 pt
-F: Afib 3 pts
-P: Pulmonary Hypertension 1pt
(PASP>35mmHg on Doppler Echo)
-E: Elder ≥ 60 years old 1 pt
-F: Elevated Filling Pressure 1pt
Total 9 points
The day Finerenone demonstrated early separation from placebo in FINEARTS-HF
What is 28
@ 24 months the SPIRIT-HF trial w/ Spiro has shown what data from the Primary endpoint to date (composite HHF and CV Death)
What is - no difference
The PARAGON-HF Trial primary outcome results
what are
-Total Hospitalization for HF & CV Death was numerically lower but not statistically significant (nor was the secondary endpoint of HHF)
The 4 classes of HF and their definitions/characteristics
What is Class I - No limitation of physical activity
What is Class II - Slight limitation of physical activity
What is Class III - Marked limitation of Physical Activity
What is Class IV - Symptoms at rest
The pittfalls that are assoc w NP assessment in HFpEF (with what groups are they often lower?) 3/5
& When they are higher
What are -HFpEF vs rEF
-obesity
-black race
-women with increased androgenicity
-insulin resistance
What is CKD
The relative risk reduction seen in FINEARTS-HF
What is 16%
@ 24 months of the SPIRIT-HF trial w/ Spiro these are the negative results to date (4)
What are
-Higher rate of total hospitalizations
-hypotension
-hyperkalemia
-1/2 spiro arm dropped out/stopped drug as this occurred during COVID
These groups may benefit from Sac-Val
Who are women or patients with EF <55-60%
These 4 criteria comprise the universal definition of HF.
What are Signs or Symptoms or both of HF caused by structural or functional cardiac abnormalities
and at least 1 of
1) elevated natriuretic peptides or
2) objective evidence of cardiogenic pulmonary or systemic congestion
This scoring system is best in primary care (3)
&
the pittfalls or additional info needed (3)
What is -HFpEF-ABA
-age
-body mass index
-A Fib
-however there is need for further investigation
-echo
-NP
-Cardiology consult
The number needed to treat in FINEARTS-HF
What is 29
This supports Eplerenon's use in HFpEF
What is -No Data
-may be considered to Spiro due to gynocomastia
Beta-Blockers are limited in HFpEF for these reasons and where might they be helpful
What is
-no established benefit in HFpEF
-poorly tolerated
-helpful in Angina or AF rate control