Closing Thoughts on Heart Failure Management

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The HCPLive Peer Exchange “Advances in Heart Failure Management” features expert opinion and analysis from leading physician specialists on the latest developments in heart failure research, diagnosis, and management.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Michael Felker, MD, MHS, Professor of Medicine, Chief of the Heart Failure Section, Director of the Heart Center Clinical Research Unit, and Director of the Advanced Heart Failure Fellowship at Duke University School of Medicine
• Jim Januzzi, MD, Roman W. DeSanctis Endowed Distinguished Clinical Scholar in Medicine at Massachusetts General Hospital and Hutter Professor of Medicine at Harvard Medical School
• Christian Schulze, MD, PhD, Associate Professor of Medicine, Division of Cardiology at Columbia University Medical Center, and Director of Research for the Center of Advanced Cardiac Care at Columbia University Medical Center

Here, the panelists offer their final thoughts to conclude all of the discussions from the Peer Exchange. According to Januzzi, “We’re seeing a renaissance in heart failure now in terms of both drug therapies as well as mechanical support options. We’re also beginning to think more broadly about the way that we deliver these therapies.”

In Felker’s words, “I think one of the things we’re seeing is this evolution from a one-size-fits-all approach” to something more akin to “personalized medicine” now that we have “all these new drugs, new strategies.”

As for Schulze, he says, “I’m personally very excited about new trials using the gene delivery methods, modified stem cells, but also plasmids for the delivery of certain modified proteins that potentially have an impact on the outcomes of patients with very advanced disease.”

In addition to medications and prevention tactics, Schulze mentions that new devices are coming to market. He says there is excitement about testing the new drugs in advanced heart failure populations, since “it is still unknown what is the optimum medical treatment in patients on left ventricular assist devices, leading them potentially to a heart transplantation.”

Looking to the future, Januzzi sees the next iteration in heart failure care strategies as “taking the results of prospective randomized trials and merging them together with good clinical care at the bed side,” as well as more targeted strategies that employ “molecular techniques such as biomarker testing to more specifically identify patients at risk who might benefit” from “new drugs that have been shown, unmistakebly, to potentially prevent progression to end-stage heart failure.”