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This Issue
Review
August4, 2020
Sean P.Murphy,MB, BCh, BAO1; Nasrien E.Ibrahim,MD2,3; James L.JanuzziJr,MD2,3,4
Author Affiliations Article Information
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1Department of Medicine, Massachusetts General Hospital, Boston
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2Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston
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3Harvard Medical School, Boston, Massachusetts
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4Baim Institute for Clinical Research, Boston, Massachusetts
JAMA. 2020;324(5):488-504. doi:10.1001/jama.2020.10262
- Original Investigation Association of Change in NT-proBNP After Starting Sacubitril-Valsartan With Cardiac Structure and Function in HFrEF
James L.JanuzziJr,MD; Margaret F.Prescott,PhD; JavedButler,MD, MPH, MBA; G. MichaelFelker,MD, MHS; Alan S.Maisel,MD; KevinMcCague,MA; AlexanderCamacho,PhD; Ileana L.Piña,MD, MPH; Ricardo A.Rocha,MD; Amil M.Shah,MD, MPH; Kristin M.Williamson,PharmD; Scott D.Solomon,MD; for the PROVE-HF Investigators
JAMA
- Original Investigation Effect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Heart Failure and Reduced Ejection Fraction
Akshay S.Desai,MD, MPH; Scott D.Solomon,MD; Amil M.Shah,MD; Brian L.Claggett,PhD; James C.Fang,MD; JosephIzzo,MD; KevinMcCague,MA; Cheryl A.Abbas,PharmD; RicardoRocha,MD; Gary F.Mitchell,MD; for the EVALUATE-HF Investigators
JAMA
- Viewpoint Redefining Heart Failure With a Reduced Ejection Fraction
JavedButler,MD, MPH, MBA; Stefan D.Anker,MD; MiltonPacker,MD
JAMA
- JAMA Patient Page Patient Information: Heart Failure
Jayson R.Baman,MD; Faraz S.Ahmad,MD, MS
JAMA
- Correction Incorrect Dosages in Table
JAMA
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RobertDowling,MD, PhD; Nathaniel L.Melton,MD; BehzadSoleimani,MD
JAMA
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Ricky D.Turgeon,BSc(Pharm), ACPR, PharmD; Arden R.Barry,BSc, BSc(Pharm), PharmD, ACPR
JAMA
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Sean P.Murphy,MB, BCh, BAO; Nasrien E.Ibhrahim,MD; James L.JanuzziJr,MD
JAMA
- Viewpoint Improving Care for Heart Failure With Reduced Ejection Fraction (HFrEF)—A Polypill-Based Strategy
AnubhaAgarwal,MD, MSc; Clyde W.Yancy,MD, MSc; Mark D.Huffman,MD, MPH
JAMA
- Original Investigation Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Heart Failure
Robert J.Mentz,MD; Kevin J.Anstrom,PhD; Eric L.Eisenstein,DBA; ShellySapp,MS; Stephen J.Greene,MD; ShelbyMorgan,BSN; Jeffrey M.Testani,MD, MTR; Amanda H.Harrington,BSW; VandanaSachdev,MD; FassilKetema,MSc; Dong-YunKim,PhD; PatriceDesvigne-Nickens,MD; BertramPitt,MD; Eric J.Velazquez,MD; TRANSFORM-HF Investigators; Kirkwood F. Adams; KunalBhatt; Tracy DeWald; Kelly M.Axsom; SandhyaMurthy; Jonathan D.Rich; Jeffrey Testani; Bryan A.Smith; Justin M.Vader; Michael D. McCulloch; Hal A.Skopicki; Mitchell A. Psotka; Alain L.Heroux; Anuradha Lala-Trindade; Gerin R. Stevens; WH WilsonTang; Yair A.Lev; PreethiWilliam; Arthur L.Eberly; Stephen S.Gottleib; W. HerbertHaught; Gillian F.Grafton; Joshua M.Larned; Lokesh K.Tejwani; Freny V.Mody; Selim R.Krim; Monique T.Robinson; James C. Fang; Alexander A.Adler; Adrian C.Bell; DipanjanBanerjee; Ernesto A.Ruiz Duque; Ahmad M.Mizyed; John J.Rommel; Justice S.Arhinful; Parag Goyal; Michael E.Hall; Scott L.Hummel; SanjayShetty; Donald C. Haas; Juan R.Vilaro; TamasAlexy; John M. Herre; John M. Clark; Andrew P.Ambrosy; Nunzio A.Gaglianello; KumudhaRamasubbu; Judith L.Meadows; Sara R.Tabtabai; MelodySherwood; SyedHasni; MichaelD'Urso; BasharatMuneer; Stephanie H.Dunlap; WilliamDavis; Dennis Friedman; Maya Guglin; Andrew D.Ferguson; AntonioAbbate; Frank Smart
JAMA
- Original Investigation Survival After CABG in Heart Failure Patients With Reduced vs and Preserved Ejection Fraction
MagnusDalén,MD; Lars H.Lund,MD, PhD; TorbjörnIvert,MD, PhD; Martin J.Holzmann,MD, PhD; UlrikSartipy,MD, PhD
JAMA Cardiology
- Original Investigation Association of Cardiovascular Biomarkers With Ejection Fraction Subtype in Heart Failure
Rudolf A.de Boer,MD, PhD; MatthewNayor,MD, MPH; Christopher R.deFilippi,MD; DanielleEnserro,PhD; VijetaBhambhani,MS, MPH; Jorge R.Kizer,MD, MSc; Michael J.Blaha,MD, MPH; Frank P.Brouwers,MD, PhD; MaryCushman,MD; Joao A. C.Lima,MD; HosseinBahrami,MD, PhD, MPH; Pimvan der Harst,MD, PhD; Thomas J.Wang,MD; Ron T.Gansevoort,MD, PhD; Caroline S.Fox,MD, MPH; Hanna KGaggin,MD, MPH; Willem J.Kop,PhD; KiangLiu,PhD; Ramachandran S.Vasan,MD; Bruce M.Psaty,MD, PhD; Douglas S.Lee,MD, PhD; Hans L.Hillege,MD, PhD; Traci M.Bartz,MS; Emelia J.Benjamin,MD, ScM; CheelingChan,MS; MatthewAllison,MD, MPH; Julius M.Gardin,MD, MBA; James L.JanuzziJr,MD; Sanjiv J.Shah,MD; DanielLevy,MD; David M.Herrington,MD; Martin G.Larson,ScD; Wiek H.van Gilst,PhD; John S.Gottdiener,MD; Alain G.Bertoni,MD, MPH; Jennifer E.Ho,MD
JAMA Cardiology
Audio Clinical Review (22:13)
Update on Congestive Heart Failure
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Abstract
Importance Worldwide, the burden of heart failure has increased to an estimated 23 million people, and approximately 50% of cases are HF with reduced ejection fraction (HFrEF).
Observations Heart failure is a clinical syndrome characterized by dyspnea or exertional limitation due to impairment of ventricular filling or ejection of blood or both. HFrEF occurs when the left ventricular ejection fraction (LVEF) is 40% or less and is accompanied by progressive left ventricular dilatation and adverse cardiac remodeling. Assessment for heart failure begins with obtaining a medical history and physical examination. Also central to diagnosis are elevated natriuretic peptides above age- and context-specific thresholds and identification of left ventricular systolic dysfunction with LVEF of 40% or less as measured by echocardiography. Treatment strategies include the use of diuretics to relieve symptoms and application of an expanding armamentarium of disease-modifying drug and device therapies. Unless there are specific contraindications, patients with HFrEF should be treated with a β-blocker and one of an angiotensin receptor–neprilysin inhibitor, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker as foundational therapy, with addition of a mineralocorticoid receptor antagonist in patients with persistent symptoms. Ivabradine and hydralazine/isosorbide dinitrate also have a role in the care of certain patients with HFrEF. More recently, sodium-glucose cotransporter 2 (SGLT2) inhibitors have further improved disease outcomes, significantly reducing cardiovascular and all-cause mortality irrespective of diabetes status, and vericiguat, a soluble guanylate cyclase stimulator, reduces heart failure hospitalization in high-risk patients with HFrEF. Device therapies may be beneficial in specific subpopulations, such as cardiac resynchronization therapy in patients with interventricular dyssynchrony, transcatheter mitral valve repair in patients with severe secondary mitral regurgitation, and implantable cardiac defibrillators in patients with more severe left ventricular dysfunction particularly of ischemic etiology.
Conclusions and Relevance HFrEF is a major public health concern with substantial morbidity and mortality. The management of HFrEF has seen significant scientific breakthrough in recent decades, and the ability to alter the natural history of the disease has never been better. Recent developments include SGLT2 inhibitors, vericiguat, and transcatheter mitral valve repair, all of which incrementally improve prognosis beyond foundational neurohormonal therapies. Disease morbidity and mortality remain high, with a 5-year survival rate of 25% after hospitalization for HFrEF.
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Citation
Murphy SP, Ibrahim NE, Januzzi JL. Heart Failure With Reduced Ejection Fraction: A Review. JAMA. 2020;324(5):488–504. doi:10.1001/jama.2020.10262
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