Deteriorating heart failure: the "last battlefield" of cardiovascular disease

Heart failure, the full name is "heart failure", is a complex set of clinical syndromes caused by abnormal changes in the structure or function of the heart caused by various reasons, resulting in ventricular systolic or diastolic dysfunction.

Prone to deterioration, high rate of rehospitalization, heart failure mortality comparable to tumor

According to statistics, there are currently more than 64 million heart failure patients worldwide.

Heart failure is easy to get worse.

In a real-world registry study that included >11,000 patients with reduced ejection fraction heart failure (HFrEF), 1 in 6 patients with chronic heart failure experienced worsening heart failure within 18 months after initial diagnosis.

The recurrent worsening of heart failure has led to a rapid decline in the survival rate of patients.

Clinical symptoms + auxiliary examination found signs of worsening heart failure

Early detection and early control of the deterioration of heart failure can minimize the harm.

(1) Chest tightness at night, difficulty breathing, sleep with a high pillow.

(2) Edema in the lower part of the body is a typical feature of aggravated heart failure.

(3) Loss of appetite and nausea.

(4) Increased urine output at night.

In this regard, Professor Zhou Jingmin from the Zhongshan Hospital of Fudan University reminded that after the above symptoms appear, auxiliary examinations such as laboratory examinations and cardiac imaging examinations are needed to make a more accurate diagnosis.

Doctor and patient work together to delay the progression of heart failure

Heart failure is a serious manifestation or terminal stage of cardiovascular disease.

Common causes of worsening heart failure include infection, myocardial ischemia, arrhythmia, elevated blood pressure, overwork, and self-reduction/discontinuation of medications.

(1) Adjust living habits and control risk factors

Living habits have a great influence on heart failure.

In addition, cardiac rehabilitation or exercise therapy is beneficial to patients with heart failure.

In addition, it is necessary to avoid excessive mood swings.

Hypertension, diabetes, obesity, etc.
are important causes of heart failure.
Long-term effective blood pressure control can reduce the risk of heart failure by 50%.
It is recommended that patients with chronic heart failure and hypertension should control their blood pressure below 130/80 mmHg.
Controlling blood sugar levels and weight loss also play an important role in delaying the progression of heart failure.
The patient must follow the doctor's advice, take the medicine on time, do not stop or reduce the dose without authorization, and do not add other drugs by themselves.

(2) Build a heart failure center to ensure standard diagnosis and treatment

Patients with heart failure need long-term, systematic and standardized treatment to control the stable condition of patients with heart failure, which is very important for the improvement of their survival rate.
Heart failure requires long-term follow-up and timely adjustment of treatment plans.
At this time, it is very necessary to build a standardized heart failure center and improve my country's comprehensive heart failure diagnosis and treatment system.

The China Heart Failure Center started its construction in 2017.
In 3 years, 1,512 registered units, 427 units have been certified, 50 demonstration bases, 22 provincial-level alliances and 12 prefecture-level alliances have been established.
After several years of development, the Heart Failure Center has established a standardized diagnosis, treatment and management system, and the use of standard drugs and the follow-up rate of patients have been improved.
Through the training and guidance of primary hospitals, a grading diagnosis and treatment system for heart failure has been gradually formed.
With the improvement of the level of diagnosis and treatment of heart failure, the rehospitalization rate and quality of life of patients have been greatly improved.

“The Heart Failure Center has achieved standardization of the diagnosis and treatment of heart failure.
Every doctor is familiar with the standardized diagnosis and treatment process, and every hospital has reached a high level of diagnosis and treatment.
Under the standard treatment plan for heart failure, patients have heart failure.
The risk of deterioration will be reduced.
" Professor Zhou Jingmin said.

New products continue to emerge and the picture of treatment for worsening heart failure is further enriched

Reviewing the history of chronic heart failure drug treatment, it can be roughly summarized into the following stages:

(1) In the era of heart and kidney treatment from 1940 to 1960, digitalis and diuretics were the core at this time;

(2) In the era of cardiac circulation therapy from 1970 to 1980, inotropic drugs and vasodilators were the core at this stage;

(3) The era of neurohormonal inhibition began in the 1990s.
At this time, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor antagonists ARB, β-receptor blockers, and aldosterone receptor antagonists ( MRA) has become the "Golden Triangle" of heart failure treatment.

Since then, angiotensin receptor enkephalinase inhibitors (ARNI), ivabradine, and SGLT-2 inhibitors have continued to be marketed, further enriching the treatment options for heart failure.
However, even with existing treatment options, patients with chronic heart failure, especially those with worsening heart failure, still have a poor prognosis and a higher risk of death.
On January 21, 2021, the soluble guanylate cyclase (sGC) stimulant Verizicator was approved for marketing in the United States, bringing new hope to patients with worsening heart failure.

The listing of Velizia is based on the positive results of its Phase III clinical VICTORIA.
The results showed that, on the basis of standard medical treatment of heart failure, compared with placebo, a 10 mg dose of velicil can reduce the relative risk of the composite endpoint of heart failure hospitalization and cardiovascular death after a worsening event by 10% (p =0.
019), the absolute risk is reduced by 4.
2/100 patient-years.

As Professor Jingmin Zhou said, different from the previous drugs, Velizia is a new type of heart failure drug with a new mechanism of action.
As a direct stimulator of sGC, Velizia is the first to target the NO-sGC-cGMP pathway in the heart.
Drugs that have achieved positive results in the field of treatment of heart failure, for patients with chronic heart failure, especially those with worsening heart failure, will be a brand-new drug treatment beyond the current standard treatments and mechanisms, which can further improve the clinical outcome of patients with heart failure .
"As clinicians, we are very much looking forward to its ability to better improve the symptoms and prognosis of patients after it is launched.
" Professor Zhou Jingmin said.

Reference materials:

QICC2020: Xiang Meixiang——Thoughts on the deterioration of chronic heart failure

Heart Online: National Heart Failure DayFocus on the prevention and treatment of heart failure to make the heartbeat more powerful

Good doctor online: a sign of worsening heart failure

Yimaitong: How to strengthen diet and exercise management for patients with heart failure?