A heart disease that is asymptomatic for a long time. The risk of death is very high

The risk of death in heart failure patients with heart failure is twice as high after a stay in hospital than before. Every patient diagnosed with heart failure is a high-risk patient, explains Prof. Małgorzata Lelonek, FESC, FHFA, head of the Department of Non-invasive Cardiology at the Medical University of Lodz. And there are about 1,3 million of these patients in Poland.

1. Heart failure is called a “silent epidemic” because the disease does not produce the typical, characteristic symptoms for a long time
2. Poland ranks first among 37 highly developed countries in terms of the number of patients hospitalized due to this disease
3. Therapy for heart failure must be intensive, fast and safe. Time is crucial: we must act in such a way as to save the patient’s life on time – emphasizes prof. Lelonek
4. More information can be found on the Onet homepage

As emphasized by prof. Małgorzata Lelonek, FESC, FHFA, head of the Department of Non-invasive Cardiology at the Medical University of Lodz, a characteristic element in heart failure is a high risk of hospitalization due to exacerbation of the underlying disease and a deteriorating prognosis after each hospital stay, resulting from the progression of heart failure.

Heart failure is a very dangerous disease

– Hospitalization in heart failure proves disease progression: the disease is progressing and current treatment turns out to be insufficient. Unfortunately, this translates into patients’ chances. The risk of mortality in heart failure is twice as high after hospitalization for heart failure than before hospitalization. We know from the PARADIGM-HF study that patients who have had a history of hospitalization for heart failure have a nearly seven times higher risk of death from cardiovascular causes than patients who have not been hospitalized for heart failure, says Prof. Małgorzata Leonek.

– We know from the same study that even if our patients have stable symptoms; they did not have an exacerbation of the disease, still as much as 20 percent. of them experiencing cardiovascular death or hospitalization due to worsening heart failure. Of this population, more than half of the patients die of sudden cardiac death (NSA). These data mean that a patient diagnosed with heart failure automatically becomes a high-risk patient regardless of other factors, both in terms of cardiovascular death and in terms of high mortality. And this high risk is additionally increased when hospitalizations occur in the course of heart failure. This means that a patient with heart failure must be treated simultaneously: quickly, intensively and immediately in the most effective way possible. Otherwise, we may not be able to save his life – he adds.

Heart failure. What are the symptoms?

According to the chairwoman of the Society of Heart Failure PTK, one of the most important advantages of modern forms of heart failure therapy is their fast and intense action. The patient experiences improvement in days, not weeks. Innovative forms of therapy are, according to prof. Małgorzata Lelonek is also safe – in the case of phyllos, they do not require laboratory parameters control, which is a serious challenge for the patient.

– After just a few days of using modern forms of pharmacotherapy, our patients admit that they breathe much easier, are more active and efficient. Patients do not get tired as easily as before the implementation of the therapy. All this has an extremely positive impact on the quality of life of patients, their sense of independence, agency, and satisfaction with life. In the field of pharmacotherapy, an interesting example of an innovative solution is dapagliflozin. This molecule has strong clinical evidence to support a reduction in mortality in patients with heart failure. In patients receiving this therapy, the DAPA-HF study showed a 17% reduction in the risk of all-cause mortality. and a reduction in mortality from cardiovascular causes by 18%. – says prof. Małgorzata Lelonek.

– In the DAPA-CKD study conducted in a group of patients with chronic kidney disease (among patients who, due to a disease coexisting with heart failure, have much more burdens and thus a worse prognosis), the proven reduction in mortality was as much as 31%! Importantly, a beneficial effect in reducing mortality was demonstrated regardless of whether the patients had heart failure or not. This means that the studied therapy was effective even in the more overburdened patients – adds the expert.

Heart failure. What does the therapy look like?

– In the PARADIGM-HF study, sacubitril / valsartan was tested not compared to placebo as for the other test molecules mentioned, up to enalapril, the active comparator. In this case, the study drug showed a reduction in mortality, which confirmed that its therapeutic effect was superior to that of the ACE inhibitor. In the DAPA-HF study, about 8 percent. patients in the study population were taking sacubitril / valsartan, but regardless of whether the patient was taking the drug or not, the effect of treatment with dapagliflozin was equally favorable. This means that dapagliflozin showed an additive benefit independent of the beneficial effects of sacubitril / valsartan. This means that the drug has the potential to further improve the quality and life expectancy of the patient. These are new possibilities of therapy – explains prof. Małgorzata Lelonek.

According to the chairwoman of the Society of Heart Failure of the Polish Cardiac Society, pharmacotherapy used in the treatment of heart failure is currently at an interesting point in its development.

– For dapagliflozin, HFrEF has documented a reduction in the risk of the primary endpoint as early as on day 28 of treatment, i.e. less than a month after starting treatment. And when the composite endpoint was extended to a visit to the Hospital Emergency Department (HED), the confirmed significance of the reduction in the primary endpoint started on day 7! It must be admitted that so far there have been no such highly effective therapies, and with regard to the life extension achieved thanks to pharmacotherapy, for example in the field of oncology (often years vs. months), innovative forms of cardiological therapy seem to be spectacularly impressive – believes Prof. Małgorzata Lelonek.

What treatment should I choose?

In the latest scheme describing the optimal treatment of heart failure, Milton Packer ii John JV McMurray proposed that treatment of patients with heart failure should start with a beta-blocker and phosin.

– When we talk about the goal of treatment, which is the reduction of mortality, as a clinician, I choose this combination for my patients: beta-blocker and dapagliflozin. If I have a high-risk patient – for example, after four hospitalizations in the last year, my first and most important goal of therapy will obviously be to protect the patient’s life. You have to act quickly and efficiently right away: in heart failure, time is of the essence. We cannot plan a multi-stage strategy with the gradual introduction of subsequent therapies, because … we may not make it on time. In other words, we must be sure that we will be able to save our patient’s life – concludes Prof. Małgorzata Lelonek.