A better understanding to improve treatment of heart failure and preserved ejection fraction

The year 2014 has become a remarkable year for heart failure. A bad start was caused by the publication of TOPCAT, showing that spironolactone did not prove to be beneficial for the treatment of patients with heart failure and preserved ejection fraction (HFpEF). Nevertheless, further insights in the study yields a few bright spots, and treatment with spironolactone might still be considered in patients with HFpEF. In acute heart failure, additional data were published on the effects of serelaxin. Serelaxin reduced wedge pressures, had similar effects in acute heart failure patients with and without a reduced ejection fraction, and had a neutral effect on diuretic response. But the most important news was related to the results of PARADIGM, where LCZ696, the first-in-class angiotensin-receptor neprilysin inhibitor, proved to be superior to enalapril in reducing mortality and morbidity in patients with heart failure and reduced ejection fraction (HFrEF).