Heart Failure Beat: HFrEF and CKD, Pirfenidone Use in HFpEF, and More

Suboptimal Care Seen Among Patients With HFrEF, CKD

According to the latest data from TRANSLATE-HF platform, a collaboration among the American Heart Association (AHA), AstraZeneca, and the Duke Clinical Research Institute, patients with heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) who had a lower estimated glomerular filtration rate were more likely to be women, older, and White.

Originally reported by Practical Cardiology^®, these patients also had higher rates of atrial fibrillation and diabetes. And for those with an ejection fraction below 40%, guideline-directed medical therapies, such as beta-blockers, were less likely if they were on dialysis. There was also a significant association between kidney function and in-hospital mortality.

Muthiah Vaduganathan, MD, MPH, cardiologist at Brigham and Women’s Hospital, presented at the American College of Cardiology’s 70th Scientific Session and explained that the primary aim of TRANSLATE-HF is “to understand the uptake and utilization of heart failure therapies among high-risk patients who are hospitalized for heart failure.” This is the second analysis from TRANSLATE-HF, and it specifically focused on kidney disease. The first was presented in November at the AHA Scientific Sessions.

Patients With HFpEF May Benefit From Pirfenidone

Fibrosis of the heart muscle among persons with heart failure with preserved ejection fraction (HFpEF) may improve following administration of the pirfenidone vs placebo, according to Pharmacy Times^®, making it an effective new treatment target for the drug, which belongs to the pyridine medication class.

Currently approved by the FDA only for use among patients with idiopathic lung fibrosis, previous data suggest pirfenidone can both reduce not only the formation of scar tissue in the heart, but present scar tissue as well. In the present study, following baseline MRI, patients were randomized 1:1 to pirfenidone or placebo and followed for 1 year. With a primary end point of change in heart muscle extracellular volume, a second MRI revealed a clinically significant volume improvement of 1.21% for the study group.

These findings suggest improvements in mortality and hospitalization among patients with heart failure. An associated reduction in natriuretic peptides was also seen in the pirfenidone group, suggesting the known heart failure indicator could be another treatment target.

REHAB-HF Trial Shows Improvement in SPPB Score

Several meaningful improvements were seen among participants with acute decompensated heart failure (ADHF) aged 60 to 99 years enrolled in the REHAB-HF trial and randomized to a transitional, tailored rehabilitation intervention following hospitalization for ADHF, according to HCP Live^®.

SPPB score improved by 1.5 points (P < .001) in the intervention group, which also saw gains in the 6-minute walk test (P = .003), Fried fraily criteria (P = .03), Kansas City Cardiomyopathy Questionnaire overall score (P = .007), and Geriatric Depression Survey-15 score (P = .018). With targets of patient strength, balance, mobility, and endurance, the 36-session intervention post discharge had both high rates of adherence and retention, at 87% and 91%, respectively. The primary end point was 3-month Short Physical Performance Battery (SPPB) score, and the key secondary end point was 6-month all-cause rehospitalizations.

REHAB-HF was taken up after lead investigator Dalane Kitzman, MD, cardiologist at Wake Forest Baptist Health, and colleagues noted that physical dysfunction among older persons with ADHF may have been overlooked as a contributing factor to poor quality of life, hospitalizations, and mortality.