Our top heart failure articles of the year cover a groundbreaking development for dapagliflozin, address the important issue of disparities in this space, and see coronavirus disease 2019 make yet another appearance.
The heart failure space saw several groundbreaking developments this year—most recently, Entresto (sacubitril/valsartan) to treat heart failure with preserved ejection fraction. Our top article of the year covers another: Dapagliflozin, originally developed to treat diabetes, was approved by the FDA to treat reduced ejection fraction disease.
Three of our remaining top 5 address the important issue of disparities, while coronavirus disease 2019 (COVID-19) makes yet another appearance, in a year that has seen the pandemic infiltrate most, if not all, facets of the medical world.
5. Heart Failure Publications, Trial Research Continue to Lack Women Authors
Twenty percent of first authors and less than 15% of senior authors in studies directed at heart failure research are women, highlighted this study from September. The bite? Women account for a quarter of physicians and researchers in the heart failure space. These statistics include the United States and Europe, both of which saw industry-sponsored trials being less likely to have women authors compared with government- and nonprofit-/university-sponsored trials.
4. How Do Hospitalizations for Heart Failure Differ Before vs During the COVID-19 Era?
This Australian study showed that patients hospitalized for heart failure during the pandemic had more advanced disease and were more symptomatic, despite hospitalizations for the disease dropping by 41% between March and April. They also had higher mean blood pressure (144/77 vs 136/74 mm Hg), more instances of New York Heart Association class III/IV disease (97% vs 68%), and fewer prescriptions for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (35% vs 57%) compared with patients admitted before the pandemic.
3. QOL Negatively Impacted by Non–Cardiovascular-Related Comorbidities Among Patients With Chronic Heart Failure
Several comorbid conditions were shown to have a detrimental effect on health-related quality of life (HRQOL). For example, depression resulted in a 200% worse HRQOL; anemia/iron deficiency, 25.6% worse; diabetes, 21.8% worse; and respiratory disease, 21.3% worse compared with patients with heart failure who did not have these comorbidities. The study authors called for clinical management to integrate comorbidity management, as doing so not only improves QOL but also provides social benefits.
2. Racial Disparities Persist for Patients With Ambulatory Heart Failure
In a year that saw issues having to do with race come front and center, this analysis of 15-year data showed that non-Hispanic Black individuals had the most instances of ambulatory heart failure vs non-Hispanic White and Mexican American individuals: 5017 vs 2746 and 2508, respectively, for 2013 through 2016. Higher rates, and earlier onset, of several risk factors among Black men and women may be to blame, and these include obesity, diabetes, and hypertension. Socioeconomic factors may also be a contributor, so public policies should specifically target this patient population to close the racial disparity gap and reap the benefits of an early diagnosis.
1. FDA Approves Dapagliflozin to Treat Heart Failure, Breaking New Ground in SGLT2 Competition
This approval marked the first time a sodium-glucose cotransporter 2 (SGLT2) inhibitor received an indication for use in adults with heart failure with reduced ejection fraction (HFrEF). Making this development even more noteworthy is that the adults who have HFrEF don’t have to have comorbid type 2 diabetes (T2D) to qualify for its use. SGLT2 inhibitors comprise a class of drugs initially developed to treat diabetes. Dapagliflozin was previously approved by the FDA in 2019 for use among adults with comorbid T2D and cardiovascular disease or other risk factors, to reduce their hospitalization risk.