Unmet Needs in the Management of Heart Failure

Anuradha Lala-Trindade, MD: I think current unmet needs for patients with mildly reduced or preserved ejection fraction are as follows. Despite the advent of SGLT2 [sodium-glucose cotransporter-2] inhibitors, which are so efficacious in this population, I think we still have a lot to learn as to how to better characterize these patients and not lump them all together. I think we recognize the groups of patients who benefit from ARNi [angiotensin receptor/neprilysin inhibitor] in the chronic setting. In the acute setting, those patients certainly with mildly reduced ejection fraction do stand to benefit from this class of drugs in these various settings.

And then you have the mineralocorticoid receptor antagonists as well, despite the controversy after the TOPCAT trial, I think there’s a large cohort of patients who benefit from this drug across the spectrum of ejection fraction and particularly also inclusive of the mildly reduced and preserved ejection fraction.

So, I think we’ve come a long way. We still need to better understand exactly how to categorize these patients better so that we can personalize and tailor our therapies. And I think we’re still learning in terms of the device-based realms, as well. In terms of relieving elevated filling pressures that develop particularly with exercise, I think we’re learning the importance. I certainly make it a point to provoke or exercise these patients who may not have symptoms at rest or evidence of congestion at rest, but who really manifest limitations in functional capacity by virtue of elevated filling pressures with exercise.

Transcript edited for clarity