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Did you know? A Bulgarian study found 79 of 142 ADR reports on cardiovascular drugs were serious. Sartans like valsartan were linked to melanoma and other cancers within 2–5 years. Statins and ACE inhibitors also showed alarming reactions like MI, heart failure, and arrhythmia—calling for more vigilant prescribing and follow-up.

Could awareness of serious ADRs like cancer from sartans influence your approach to monitoring patients and selecting cardiovascular treatments?

NCCN Guidelines

Could awareness of serious ADRs like cancer from sartans influence your approach to monitoring patients and selecting cardiovascular treatments?

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Genetic mutations were found in 71% of arrhythmia patients with cardiac devices. Variants in TMEM43 and titin (TTN) are linked to poor CRT outcomes. Personalised selection, such as using transvenous ICDs for ACM, improves prognosis and care.

Leverage genetics to tailor cardiac care

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case study

 

Patient background

A 68-year-old man with a history of hypertension and type 2 diabetes presents with acute decompensated heart failure, reporting progressive dyspnea, two-pillow orthopnea, and bilateral lower extremity edema. He has a 5-year history of chronic heart failure with reduced ejection fraction (HFrEF) but has only been on loop diuretics for the past year, with no other components of guideline-directed medical therapy (GDMT) prescribed. His family history is notable for premature cardiovascular deaths in first-degree relatives.

Assessment and diagnosis 

On exam, the patient had diminished breath sounds, bilateral basal crackles, elevated jugular venous pressure, and pitting edema to the mid-shins. His oxygen saturation was 95% on room air. Echocardiogram revealed a reduced left ventricular ejection fraction (LVEF) of 25%, confirming HFrEF. Laboratory evaluation showed serum creatinine 1.4 mg/dL, eGFR 48 ml/min/1.73m², and potassium 4.2 mEq/L. Following treatment with intravenous loop diuretics, he achieved near-euvolemia and maintained a stable systolic BP of 115 mmHg without requiring inotropic support. Final diagnosis: acute on chronic HFrEF. Plans were made to initiate GDMT during hospitalization and to schedule outpatient follow-up for reassessment and titration.

  1. How do you initiate and optimize guideline-directed medical therapy in acute decompensated heart failure?
  2. How do you integrate newer agents like SGLT2 inhibitors into established GDMT sequencing in your practice?
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Interatrial Shunt Treatment for Heart Failure: The Randomized RELIEVE-HF Trial - PubMed

Interatrial Shunt Treatment for Heart Failure: The Randomized RELIEVE-HF Trial - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/39308371/

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03499236.

Interatrial shunt implantation was safe in HF patients but showed benefit only in reduced LVEF, while worsening outcomes in preserved LVEF.

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Consequences of Discontinuing Long-Term Drug Treatment in Patients With Heart Failure and Reduced Ejection Fraction - PubMed

Consequences of Discontinuing Long-Term Drug Treatment in Patients With Heart Failure and Reduced Ejection Fraction - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/39453366/

There is uncertainty regarding the clinical effects of discontinuation of drugs for heart failure after long-term use. The withdrawal of long-term treatment can follow 1 of 4 distinct patterns: 1)...

Heart failure drug withdrawal often leads to clinical deterioration, with varied persistence of effects across agents. Evidence underscores avoiding treatment gaps and maintaining foundational therapies for optimal outcomes.