That they are still trying to invent heart drugs speaks to how medicine is stuck in the stone age. Herbs, vitamins and minerals offer much more with little risk of aftershocks. Even diet can help.
Being retired for a number of years and not very interested in keeping up with the new terminology, can someone explain to me why heart failure with a normal ejection fraction is called heart failure? This appears to be an old and proven pharma strategy: develop and market a new drug that has a marginal effect in a study to replace an older drug that has the same marginal effect but most importantly has gone off patent.
Volume overload with relatively normal kidney and liver function. We tend to pin this on the heart. Often it’s related to stiff and inelastic myocardium (poor diastolic function) but it’s also become somewhat of a grab bag term.
Thank you. That is pretty much what I suspected---some sort of cardiomyopathy that restricted diastolic filling. In almost 40 years of practice, I can't recall ever seeing this. Some severe hypertensives might have enough LVH to give this sort of problem, but they almost always had significant renal dysfunction as well.
On the basis of Finearts, I will be using spiro more for HFpEF pts than I had previously….and when Finerenone is approved and we know how much it will cost….I will probably still be using spiro more, and reserve Finerenone for those who truly cannot tolerate spiro.
As for the primary composite outcome result being driven by “HHF” type events, I was unable to find in the paper what the difference was in actual HF hospitalizations, vs “urgent HF visits”. As soft endpoints go, I put more weight on an actual admission than I do an unscheduled heart function clinic visit or need for an outpatient dose of IV lasix.
“Steroidal MRAs (finerenone) reduce the risk of cardiovascular death or heart failure hospitalisation in patients with HFrEF and non-steroidal MRAs reduce this risk in patients with HFmrEF or HFpEF.”
Is it a typo to refer to finerenone as a steroidal MRA?
Appreciate the breakout. It leaves an obvious need to pursue the head to head. Costly or not, this is a huge population and definition of benefit is in itself a cost savings of incredible magnitude.
If finerenone decreased the risk of hyperkalemia, that could be worthwhile, even if the outcomes were the same. For a frail patient whose children have to take time off from work to take them to the lab for their blood draws, less fussing about the potassium is a plus. The study indicates a slight bump compared to placebo. The real comparison I want, of course, is to spironolactone.
That they are still trying to invent heart drugs speaks to how medicine is stuck in the stone age. Herbs, vitamins and minerals offer much more with little risk of aftershocks. Even diet can help.
Please note Finerenone is a non-steroidal MRA, not steroidal.
Interesting thank you! Does anyone have data or experience around how Eplerenone fits into this equation? Thanks
Being retired for a number of years and not very interested in keeping up with the new terminology, can someone explain to me why heart failure with a normal ejection fraction is called heart failure? This appears to be an old and proven pharma strategy: develop and market a new drug that has a marginal effect in a study to replace an older drug that has the same marginal effect but most importantly has gone off patent.
Volume overload with relatively normal kidney and liver function. We tend to pin this on the heart. Often it’s related to stiff and inelastic myocardium (poor diastolic function) but it’s also become somewhat of a grab bag term.
Thank you. That is pretty much what I suspected---some sort of cardiomyopathy that restricted diastolic filling. In almost 40 years of practice, I can't recall ever seeing this. Some severe hypertensives might have enough LVH to give this sort of problem, but they almost always had significant renal dysfunction as well.
On the basis of Finearts, I will be using spiro more for HFpEF pts than I had previously….and when Finerenone is approved and we know how much it will cost….I will probably still be using spiro more, and reserve Finerenone for those who truly cannot tolerate spiro.
As for the primary composite outcome result being driven by “HHF” type events, I was unable to find in the paper what the difference was in actual HF hospitalizations, vs “urgent HF visits”. As soft endpoints go, I put more weight on an actual admission than I do an unscheduled heart function clinic visit or need for an outpatient dose of IV lasix.
My patients who developed gynecomastia on spironolactone also developed it on the new expensive cousin
“Steroidal MRAs (finerenone) reduce the risk of cardiovascular death or heart failure hospitalisation in patients with HFrEF and non-steroidal MRAs reduce this risk in patients with HFmrEF or HFpEF.”
Is it a typo to refer to finerenone as a steroidal MRA?
Yes, will fix
Appreciate the breakout. It leaves an obvious need to pursue the head to head. Costly or not, this is a huge population and definition of benefit is in itself a cost savings of incredible magnitude.
All that is new is not necessarily better, but all it is new is always much more expensive.
I will continue to use spiirolactone until unacceptable side effects occur and only then switch.
Ben Hourani , MD, MBA
If finerenone decreased the risk of hyperkalemia, that could be worthwhile, even if the outcomes were the same. For a frail patient whose children have to take time off from work to take them to the lab for their blood draws, less fussing about the potassium is a plus. The study indicates a slight bump compared to placebo. The real comparison I want, of course, is to spironolactone.
Typo in subtitle.