PROMPT-HF, SODIUM-HF, and Improving Data-to-Practice Heart Failure Care

To many, the headline discussion at the American College of Cardiology (ACC) 2022 Scientific Sessions in Washington, DC, this weekend was regarding the evolution of heart failure strategies—from pharmacotherapy to lifestyle intervention, from updated recommendations to greater discussion around pragmatic research.

In the second segment of an interview with HCPLive during ACC 2022, Larry Allen, MD, medical director of heart failure at University of Colorado Anschutz School of Medicine, discussed his interest in some of the meeting’s key contributions to heart failure research.

Regarding the PROMPT-HF trial, which assessed the prevalence of adequate evidence-based outpatient treatment for heart failure, Allen shared his own frustrations with real-world heart failure prescribing strategies. As he noted, titration of beta blocker to goal doses is often failed, uptake of sacubitril valsartan since it first was approved in 2015 has been slowed, and worry of early-observed safety issues with eplenerone/sprionolactone is impacting its uptake.

“How do we take what we know and what’s been shown to work in randomized trials, and do a better job of making sure that our patients in everyday practice are getting those therapies?” Allen prosed. “And there’s a lot of data out there that’s disappointing.”

Allen stressed that his peers need to figure out how to progress stable yet at-risk patients from outpatient care to prescribed therapies indicated to reduce likelihood of recurrent events. “You get strong data to show that drugs like that can be very helpful, and yet, the minority of people who qualify for those drugs—which are generic now—are not getting them,” he explained. “So I think there’s a lot of work to do.”

Some of that strategy may entail “making it easier to do the right thing” for prescribing clinicians and engaged patients alike, Allen said. He cited his own team’s emphasis on trialing and initiating quadruple heart failure therapy regimens with hospitalized patients prior to their discharge, while pharmacists work to ensure costs and coverage are feasible.

“So when patients leave, they know what their regimen should be, they know what the cost is going to be, they already tried the drugs and know they can tolerate them, and that makes their future care that much easier,” Allen said.

Allen additionally discussed the newest heart failure guideline recommendations, as well as the SODIUM-HF trial—a pragmatic assessment into the impact of high-sodium diets on heart failure burden—and the need for continued research into the role of lifestyle intervention.

“I might see a patient for a half an hour, once a month,” Allen said. “But patients live with themselves 24/7, 365. And in addition to taking medicines a few times a day, they’re dealing with heart failure with all of their behaviors.”