Matching Treatments to “Correct” HF-PEF Patients is Vital for Efficacy

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shutterstock_148867001A 2011 study entitled, “Pulmonary hypertension in heart failure with preserved ejection fraction: a target of phosphodiesterase-5 inhibition in a 1-year study” identified the fact that prevalence of heart failure with preserved ejection fraction is increasing in the patient population, and that patient prognosis worsens among those with pulmonary hypertension (PH). As a result, research into preserved ejection fraction (HF-PEF) remains associated with PH-released research.

Although the difference between the two is only slight, heart failure with preserved ejection fraction (HF-PEF) is a unique and separate disease from heart failure with reduced ejection fraction (HF-REF). However, as noted by the European Heart Journal article “New Strategies for Heart Failure with Preserved Ejection Fraction: The Importance of Targeted Therapies for Heart Failure Phenotypes,” medical insights into HF-PEF is much less than that of HF-REF, leaving a gap in effective treatments for patients with HF-PEF.

Large phase 3 international clinical trials have been completed with the goal of improving the outcome in HF-PEF, but the results have been disappointing. Therefore, no standards of care have been set, and treatments are based on empirical observations.

Perhaps the reason these clinical trials failed to improve HF-PEF patient outcome is that the disease is not well understood and patients tend to present with heterogeneous symptoms and pathophysiologies. Breathlessness during the night, fatigue during the day, reduced exercise performance, elevated jugular pressure, and pulmonary crackles can all be observed and used to diagnose HF-PEF according to at least three clinical diagnostic guidelines.

As a result, administered treatments targeted toward certain groups, with or without comorbidities, may be the solution to improving treatments. For example, the journal article suggests matching sodium channel blockers to patients with ischemia and metformin to patients with diabetes or other metabolic syndromes.

A few up-and-coming treatments have been developed to treat patients with HF-PEF. These include interventions to address electrical and mechanical dyssynchrony, renal function and fluid homeostasis, autonomic dysfunction, and altered heart rate.

In order for any of these treatments to be successfully proven effective in clinical trials, it is vital to design the trials well and enroll the correct patients for which the treatment may be most effective. By following these rules of thumb, HF-PEF treatments may one day be just as effective as those to treat HF-REF.

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Maureen Newman is a science columnist for Pulmonary Hypertension News. She is currently a PhD student studying biomedical engineering at University of Rochester, working towards a career of research in biomaterials for drug delivery and regenerative medicine. She is an integral part of Dr. Danielle Benoit's laboratory, where she is investigating bone-homing therapeutics for osteoporosis treatment.
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