New strategies for heart failure with preserved ejection fraction: The importance of targeted therapies for heart failure phenotypes

Michele Senni, Walter J. Paulus, Antonello Gavazzi, Alan G. Fraser, Javier Díez, Scott D. Solomon, Otto A. Smiseth, Marco Guazzi, Carolyn S P Lam, Aldo P. Maggioni, Carsten Tschöpe, Marco Metra, Scott L. Hummel, Frank Edelmann, Giuseppe Ambrosio, Andrew J Stewart Coats, Gerasimos S. Filippatos, Mihai Gheorghiade, Stefan D. Anker, Daniel LevyMarc A. Pfeffer, Wendy Gattis Stough, Burkert M. Pieske

Research output: Contribution to journalArticle

Abstract

The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed.

Original languageEnglish
Pages (from-to)2797-2811d
JournalEuropean Heart Journal
Volume35
Issue number40
DOIs
Publication statusPublished - Oct 21 2014

Keywords

  • Clinical trial
  • Diabetes mellitus
  • Exercise tolerance
  • Heart failure, Diastolic
  • Phenotype
  • Preserved ejection fraction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Senni, M., Paulus, W. J., Gavazzi, A., Fraser, A. G., Díez, J., Solomon, S. D., Smiseth, O. A., Guazzi, M., Lam, C. S. P., Maggioni, A. P., Tschöpe, C., Metra, M., Hummel, S. L., Edelmann, F., Ambrosio, G., Coats, A. J. S., Filippatos, G. S., Gheorghiade, M., Anker, S. D., ... Pieske, B. M. (2014). New strategies for heart failure with preserved ejection fraction: The importance of targeted therapies for heart failure phenotypes. European Heart Journal, 35(40), 2797-2811d. https://doi.org/10.1093/eurheartj/ehu204