Recapping the Heart Failure Summit 2021

PCNA Board President Sandra Dunbar authored this informative recap of the 2021 Heart Failure Summit.

The number of adults in the United States with heart failure is over 6 million, and this number continues to expand with more than eight million individuals expected to be affected by 2030.1 With nearly 1 million people hospitalized for heart failure annually and nearly 1 in 4 patients facing readmission within 30 days of discharge,2 there is a tremendous toll on the quality of life for patients, families, and caregivers.3

There is a related, substantial, impact on cardiovascular nursing. In the 2021 survey of PCNA members and others involved in PCNA activities, more than 80% of respondents indicated they care for patients with heart failure and that the need to stay current with guidelines-based practice is front-of-mind. At PCNA’s second annual Heart Failure Summit held on December 2021, attendees learned state of the science information through a review of guidelines and related case studies. Over 200 individuals participated in the live sessions, which are recapped below.

Recacp of the 2021 Heart Failure Summit

Colleen McIlvennan, PhD, DNP, ANP, FAHA, FHFSA, kicked off the program with a compelling presentation focusing on the new and emerging treatment for persons with HFrEF (heart failure with reduced ejection fraction) and HFpEF (heart failure with preserved ejection fraction). Dr. McIlvennan provided an overview of the current guidelines for managing heart failure, including HFrEF, HFpEF, and the disease states of heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with improved ejection fraction (HFimpEF).

Dr. McIlvennan described evidence for the four pillars of quadruple therapy for heart failure including —ARNi (angiotensin receptor neprilysin inhibitor), beta-blocker, MRA (mineralocorticoid receptor antagonists), with the newest one as SGLT2-inhibitors. Each of these pillars has a risk reduction ratio (RRR) of 30-35% in death and hospitalization, and together as quadruple therapy yield a 73% RRR for death.4 She also shared details from recent clinical trials, including those identifying the role of SGLT2 inhibitors in heart failure management, and case studies and tools demonstrating how shared decision-making can be applied in the treatment options for both HFrEF and HFpEF.

Last updated in 2017, the newest updates to the AHA/ACC heart failure guidelines are expected in April 2022—so stay tuned for this forthcoming newest information.

Connie White-Williams, PhD, RN, NE-BC, FAHA, FAAN, presented on the relationship between Social Determinants of Health (SDOH) and Heart Failure. Using the definition of SDOH by the World Health Organization as the framework, conditions in which people are born, grow, work, live and age…and the wider set of systems that shape conditions of daily life, Dr. White Williams focused on the impact of SDOH on health outcomes. The relationships are measurable on our patients in term of their physical health, behavioral health, and their social health, and our patients with heart failure are no exception. For example, patients with heart failure that do not have access to care receive insufficient follow-up for heart failure treatment, utilize the emergency department for routine care when they are uninsured, and endure frequent readmissions.5,6

Dr. White Williams focused on three specific areas of SDOH: access to care, food insecurity, and access to medication, and described a model of care that addresses these three categories in the clinical setting in which she works. By addressing these basic needs of patients through an array of innovative interventions and community resources, patients with heart failure can experience improved outcomes with savings in their personal and health resource use costs.

The conversation about SDOH and heart failure continued with Nancy Albert, RN, PhD, CCNS, CHFN, CCRN, NE-BC, FCCM, FAHA, FHFSA, FAAN presenting on Social Determinants of Health across race and gender. The prevalence of heart failure globally is higher in women 7,8,9, and women are more likely to have comorbid conditions. Women are also less likely to enroll in, and complete, cardiac rehabilitation programs,10,11 and are less likely to be considered eligible for advanced treatments.12 These and other factors can lead to a lower quality of life for women, with more signs/symptoms, higher pain scores, and greater psychological and physical disability.13

Dr. Albert also shared observed differences in heart failure outcomes by race. Individuals who are black have a higher age-adjusted heart failure-related cardiovascular disease mortality.14 Non-white individuals also have a lower quality of life, are prescribed different treatments, and are treated less frequently by a cardiologist for their primary care in the ICU than patients who are white—despite the fact that admission by a cardiologist compared with a non-cardiologist was associated with better in-hospital survival, irrespective of race.15 Dr. Albert inspired the audience by addressing multiple strategies for addressing SDOH that can be applied in clinical practice to help make equitable care the norm rather than the exception.

The Summit was wrapped up with a presentation by Jane Linderbaum MS, ARNP, FACC, addressing case-based management of patients with hypertrophic cardiomyopathy (HCM). Her excellent presentation focused first on identifying the signs, symptoms, and diagnostic criteria for HCM, which can be challenging to diagnose, including the initial tests and diagnostic criteria that can be used to rule out other similar, conditions and diseases. Assessments include physical examination and tests such as ECG, history, and symptomology. Once diagnosed, additional tests provide information to guide care and treatment decisions. These might include Holter monitoring to assess for asymptomatic nonsustained ventricular tachycardia and risk for sudden cardiac death (SCD), treadmill tests to determine risk stratification, and a stress echo to assess for outflow gradient. An MRI provides information about left ventricular anatomy, and a hemodynamic catheterization may be indicated if the echo is not definitive or there is high clinical concern for obstruction. For patients who are identified as having HCM, family genetic screening and surveillance are important in reducing the risk of SCD.

Jane also described the importance of shared decision-making with patients with HCM and discussed treatments, which range from medical therapy to surgery to help relieve patient symptoms and to prevent SCD.

A final component of the Heart Failure Summit included an interesting presentation about recurrent pericarditis, and a new treatment option, rilonacept, for ages 12 and older.

Look for more information on PCNA’s 3rd annual heart failure summit in late 2022!

PCNA is grateful to the sponsors of the 2021 Heart Failure Summit: Bristol Myers Squibb, Kiniksa Pharmaceuticals, Merck Sharpe & Dohme Corp., and Novartis Pharmaceuticals Corporation.

Refernces

  1. Virani SS, Alonso A, Aparicio HJ, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143:e254–e743. doi: 10.1161/CIR.0000000000000950
  2. Dharmarajan K, Hsieh AF, Lin Z., et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 23 January 2013;309(4):355-63. doi: 10.1001/jama.2012.216476
  3. Global Coalition on Aging (2020). Tackling Heart Failure as We Age: Best Practices in Heart Failure Detection, Diagnosis, Treatment and Care. Global Alliance on Heart Failure and Healthy Aging.
  4. Bassi NS, Ziaeian B, Yancy CW, Fonarow GC. Association of optimal implementation of sodium-glucose cotransporter 2 inhibitor therapy with outcome for patients with heart failure. JAMA Cardiol. 2020;5(8):1–5. doi:10.1001/jamacardio.2020.0898
  5. Khan MS, Sreenivasan J, Lateef N, et al. Trends in 30- and 90-Day Readmission Rates for Heart Failure. Circulation: Heart Failure. 2021;14:e08335. doi: 10.1161/CIRCHEARTFAILURE.121.008335
  6. Psotka MA, Fonarow GC, Allen LA, et al. The hospital readmissions reduction program: nationwide perspectives and recommendations: a JACC: heart failure position paper. JACC Heart Fail. 2020;8(2):1-11. doi: 10.1016/j.jchf.2019.07.012
  7. Lippi G, Sanchis-Gomar F. Global epidemiology and future trends of heart failure. AME Med J. 2020;5:15. doi: 10.20137/amj.2020.03.03
  8. Kenchaiah S, Vasan RS. Heart Failure in women—insights from the Framingham Heart Study. Cardiovasc Drugs Ther. 2015;29:377-390.
  9. Hsich EM, Grau-Sepulveda MV, Hernandez AF, et al. Relationships between sex, ejection fraction, and B0type natriuretic peptide levels I patients hospitalized with heart failure and associations with inhospital outcomes: findings from the Get With The Guideline-Heart Failure Registry. Am Heart J. 2013;166:1063-71. doi: 10.1016/j.ahj.2013.08.029
  10. Lam CSP, Arnott C, Beale AL, et al. Sex differences in heart failure. Eur Heart J. 2019;40(47):3859-386868c. doi: 10.1093/eurheartj/ehz835
  11. Aggarwal M, Bozkurt B, Panjrath G, et al. Lifestyle Modifications for Preventing and Treating Heart Failure. J Am Coll Cardiol. 2018;72(19):2391-2405. doi: 10.1016/j.jacc.2018.08.2160
  12. Steinberg RS, Nayak A, Burke MA, et al. Association of race and gender with primary caregiver relationships and eligibility for advanced heart failure therapies. Clin Transplant. 2021 Oct 11:e14502. Online ahead of print. doi: 10.111/ctr.14502.
  13. Swaraj S, Kozor R, Arnott C, et al. Heart Failure with Reduced Ejection Fraction—Does Sex Matter? Curr Heart Fail Rep 2021;18(6):345–352. doi: 10.1007/s11897-021-00533-y
  14. Glynn P, Lloyd-Jones DM, Feinstein MJ, et al. Disparities in Cardiovascular Mortality Related to Heart Failure in the United States. J Am Coll Cardiol. 2019;73(18):2354-2355. doi: 10.1016/j.jacc.2019.02.042.
  15. Breathett K. Liu WG, Allen LA, et al. African-Americans Are Less Likely to Receive Care by a Cardiologist During an Intensive Care Unit Admission for Heart Failure. JACC Heart Fail. 2018;6(5):413-420. doi: 10.1016/j.jchf.2018.02.015

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