title: Heart failure - what's new and what's changed?
abstract: Physicians responsible for the care of patients with heart failure due to left ventricular systolic dysfunction have access to a broad range of evidence-based treatments that prolong life and reduce symptoms. In spite of the significant progress made over the last four decades, there is an ongoing need for novel therapies to treat a condition that is associated with stubbornly high morbidity and mortality. In this article, we discuss the findings of SERVE-HF, a randomised controlled trial of adaptive servo-ventilation in patients with left ventricular systolic dysfunction, as well as EMPA-REG, a study of the effects of a novel diabetic agent that may be of greater interest to heart failure specialists than diabetologists. We also examine further analyses of the groundbreaking PARADIGM-HF trial, which attempt to answer some of the unresolved questions from the original study of the first combined angiotensin-receptor blocker and neprilysin inhibitor, sacubitril valsartan. The recently published National Institute for Health and Care Excellence guidelines for the management of acute heart failure and plans to introduce best practice tariffs bring into focus the need for well-organised, multidisciplinary care. We discuss the challenges involved in developing and delivering a specialist service that meets the needs of a growing population of patients living with heart failure.
authors.affiliation: Advanced Heart Failure and Cardiac Transplantation, University Hospital of South Manchester, Manchester, UK paulcallan843@btinternet.com.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Callan
authors.affiliation: Hull York Medical School and honorary consultant cardiologist, Hull and East Yorkshire NHS Hospitals Trust, York, UK.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D001713:Biphenyl Compounds; D048909:Diabetes Complications; D004338:Drug Combinations; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D011175:Positive-Pressure Respiration; D017410:Practice Guidelines as Topic; D020182:Sleep Apnea, Central; D013777:Tetrazoles; D000068756:Valsartan
chemical_list: D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D001713:Biphenyl Compounds; D004338:Drug Combinations; D013777:Tetrazoles; D000068756:Valsartan; C549068:sacubitril and valsartan sodium hydrate drug combination
keywords: Adaptive servo-ventilation; angiotensin receptor neprilysin inhibitors; clinical trials; diabetes mellitus; heart failure; organisation of care