Three newly published studies in JACC Journals examine key aspects of heart failure (HF): a multi-level polypill strategy for patients with HF with reduced ejection fraction (HFrEF); the impact of HF with preserved ejection fraction (HFpEF) on individuals with atrial fibrillation (AFib); and the incidence of HF among adults with chronic kidney disease (CKD). Collectively, these studies contribute to the expanding body of evidence highlighting emerging risks and evolving treatment strategies across the HF spectrum.
In JACC: Advances, a study conducted by Justin C. Chen, MD, MHPE, et al., identifies four key themes impacting effective use of a polypill-based strategy for HFrEF, including the current state of HFrEF along with awareness of new innovations, ability to assess innovation appropriateness and building competency in HFrEF care. Based on these themes, the study highlights seven potential components to an implementation bundle that are focused on facilitation; a staged implementation plan; adapting and tailoring the plan to stakeholders; quality management; knowledge broker; team-based care, engagement and feedback; and the HFrEF polypill itself.
“To achieve widespread equitable implementation and sustained improvements in patient outcomes, interventions must be strategically developed, adapted to contextual factors, and described in detail to promote dissemination,” write Chen, et al., who hope their conceptual model will help inform future trials on this topic.
In a related editorial comment, Quan M. Bui, MD, FACC, and Max Jason, MD, write that “beyond the scope of this study, a more fundamental question remains: Is a fixed-dose combination polypill the solution to the complex challenge of [guideline-directed medical therapy] uptake in HFrEF?” They note: “While polypills may eventually prove beneficial in select settings, large-scale validation in diverse HFrEF populations is still lacking. In the meantime, we should prioritize implementation of proven, multifaceted strategies that are already available and cost-effective.”
In another study published in JACC: Clinical Electrophysiology, Jonathan P. Ariyaratnam, MB BChir, PhD, et al., found obesity and epicardial adipose tissue volumes (EATV) were associated with worse hemodynamics and higher prevalence of HFpEF in patients with AFib.
Ariyaratnam and colleagues note that the hemodynamic abnormalities were “driven by extrinsic pericardial restraint as well as accelerated intrinsic left atrium dysfunction.” Based on the findings, they suggest that patients with obesity and increased EATV “may benefit from additional HFpEF and weight loss therapies to reduce this risk.”
In a JACC: Heart Failure study, Michael P. Girouard, MD, MBA, et al., found that the incidence of HF is common in adults with mild to moderate CKD, largely driven by HFpEF. These findings, the authors note, “align with the current understanding of the common underlying pathophysiology between HFpEF and CKD,” and “highlight the potential for synergistic management” of AFib using new therapies that are showing promise in improving both cardiovascular and renal outcomes.
“Collaboration is needed among cardiologists, nephrologists, and primary care physicians to identify and better understand specific strategies to prevent or delay the progression of early CKD in the hopes of reducing downstream HF-related morbidity and mortality,” say Girouard and colleagues.