Authors:
B. Blake Miller, PharmD, BCPS
Jennifer N. Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM
Reviewers:
Sarah Anderson, PharmD, BCPS, BCACP
Megan Supple, PharmD, BCACP
Citation: Ferreira JP, Zannad F, Pocock SJ, et al. Interplay of mineralocorticoid receptor antagonists and empagliflozin in heart failure – EMPEROR-Reduced. J Am Coll Cardiol 2021;77:1397-407.
The Problem
Going from heart failure (HF) to heart success sounds pretty “sweet” right? We now have “diabetes medications” to treat HFrEF. Despite the availability of many evidence-based medications for HFrEF that can significantly reduce mortality and hospitalizations, unfortunately, many patients remain undertreated. According to one large US registry, less than 1% of patients with HFrEF were concurrently treated with target doses of guideline-directed medical therapy (GDMT) consisting of either angiotensin-converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB), or angiotensin receptor-neprilysin inhibitor (ARNI) PLUS beta-blocker PLUS mineralocorticoid receptor antagonist (MRA).1 Nearly 30% of patients with HF will die within 1 year and 40-50% of patients will die within 5 years. Moreover, HF is a very costly clinical syndrome. Between 2012 and 2030, we’re expected to see a 46% increase in patients with HF in the US resulting in a 127% increase in total costs (around $70 billion). Most of these costs are due to hospitalizations; HF is associated with higher rates of 30-day readmissions than any other diagnosis.2 Thus, it is critically important to add, titrate, and adjust GDMT and focus on patient adherence strategies in order to improve patient outcomes (reduce mortality and hospitalizations).
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I really enjoyed this episode. You make a great point about pill burden for these heart failure patients; do you believe combination products are on the horizon? Are fixed dose combination products safe in these types of patients where adjustments may be necessary depending on status? Great work. Thanks.
Thank you for the comment. I am not aware of any combination products on the horizon. If available in the future, it would be important to evaluate the strengths, as some make require adjustments based on the patient’s clinical status. In addition, cost may be an issue depending on the combined products and in some cases, multiple products may be cheaper.