*For medical professionals reading reference only
This is a heart failure patient with multiple diseases. After meeting the conditions, he took Vilixigua treatment and titrated to a 10mg target dose as planned. After treatment, the patient's heart failure symptoms improved significantly, and he was admitted to hospital without heart failure during the study period.
Comment Expert
Professor Zhang Hong
Doctor, chief physician, master's supervisor, State Council special allowance expert
Shanxi Provincial People's Hospital Director of Cardiology
Standing Committee Member of the Critical Care Professional Committee of the Chinese Medical Association
Chairman of the Critical Care Professional Committee of the Shanxi Medical Association
Deputy Chairman of the Cardiovascular Branch of the Shanxi Medical Association
Vice Chairman of the Electrophysiology and Pacing Branch of the Shanxi Medical Association
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Shanxi Provincial Cardiovascular Disease Intervention Quality Control Department
Handwich Medical Association Deputy Chairman of Heart Failure Committee
Shanxi Provincial Medical Association Cardiac Rehabilitation Professional Committee Deputy Chairman of Shanxi Provincial Medical Association
Shanxi Provincial Medical Association Hypertension Professional Committee Deputy Chairman of Shanxi Provincial Medical Association
Shanxi Provincial Medical Association Hypertension Professional Committee
Deputy Director of Shanxi Provincial Primary Health Cardiovascular Professional Committee
Heart failure patients with multiple comorbidities,
Optimized treatment is very critical
Survey shows that the prevalence of heart failure over 35 years old in my country is about 1.3%. It is estimated that the number of patients with heart failure is about 13.7 million [1]. As the final battle for cardiovascular disease treatment, heart failure itself is difficult to treat, and the overall hospitalization mortality rate of heart failure is about 4.1% [2].
But it is particularly important to note that with the aging of population and the increase in the incidence of chronic underlying diseases such as hypertension , coronary heart disease , diabetes , most patients with heart failure have at least one comorbidity. Heart failure and comorbidities affect each other, and the combined medication is also more complicated, which brings certain difficulty to the treatment. Therefore, how to optimize the management of patients with heart failure with multiple comorbidities is also an issue that needs attention in clinical practice.
In the previous case, 's first soluble guanylate cyclase (sGC) stimulator for heart failure, Vilixigua, has shown outstanding performance in improving the rehospitalization of patients with heart failure. So what is the therapeutic effect of Vilixigua on patients with complex heart failure with multiple comorbidities? Let's take a look together.
Vilixigua can reduce the re-hospitalization of patients with multiple comorbidities of heart failure, and is well safe
Case provider
Doctor Li Min
Shenzhen Provincial People's Hospital attending physician
Shenzhen Provincial Physician Association Cardiology Critical Care Professional Committee
Shenzhen Medical Association Cardiology Critical Care Professional Hypertension Group Secretary
Hydrogenics Committee of Shanxi Medical Association Cardiology Critical Care Professional Hypertension Group
Hydrogenics Committee of Shanxi Medical Association Cardiology Critical Care Professional Hypertension Group
Hydrogenics Committee of Shanxi Medical Association Cardiology Rehabilitation Committee
Hydrogenics Committee of Shanxi Medical Association
Member of the Special Committee of Cardiovascular Metabolic Diseases of Shanxi Health Association
Case information
Basic information: Patient, female, 53 years old.
main complaint: intermittent chest pain, shortness of breath for 1 and a half years, worsening by 1 month.
Current medical history: The patient had chest pain, , shortness of breath after activity in July 2016, and relieved after rest for several minutes. The degree of exercise worsened and decreased exercise endurance. He visited a hospital in Shanxi, considering " ischemic cardiomyopathy , heart failure", etc., and was given anti-infection, cardiogenic diuresis, blood vessel expansion, etc., with poor results. After that, he was repeatedly admitted to the hospital for treatment for one and a half years. In December 2017, he gradually developed general swelling, accompanied by general weakness and shortness of breath, unable to lie flat at night, and reduced urine volume (200-400ml/d), accompanied by cough and sputum, which was white foamy sputum, accompanied by slight . He injected human albumin into his home and took oral tovaptanri diuresis, but the symptoms of shortness of breath and general swelling did not improve. Therefore, he visited the Department of Cardiology of our hospital on December 13, 2017. The history of hypertension is more than one year, and the highest blood pressure is 150/80mmHg; the history of diabetes is 17 years, and blood sugar control is still acceptable; in May 2017, " diabetic nephropathy , diabetic retinopathy, diabetic peripheral neuropathy, and chronic renal failure (decompensation period)" was diagnosed.
Past history: In July 2016, " secondary tuberculosis " was diagnosed in a hospital in Shanxi.
Physical examination: Pulse is 97 beats/min, breath is 20 beats/min, and blood pressure is 117/84mmHg. Normal development, positive body shape, moderate nutrition, acute face, clear consciousness, physical examination cooperation, passive position, jugular vein , low breathing sound of the right lung, can hear wet rales, no dry and wet rales in the left lung. Abdomen bulges, no tenderness, rebound pain, , liver and spleen under the ribs touching, severe swelling and swelling of the face, abdominal wall, lumbar sacral part and both lower limbs.
Heart examination: heart boundary expands to the left, heart rate : 97 times/min, smooth, no obvious noises were heard in each valve auscultation area.
Auxiliary examination
Table 1 Patient auxiliary examination laboratory indicators
Table 2 Patient auxiliary examination imaging indicators
Preliminary diagnosis: Coronary atherosclerotic heart disease (ischemic cardiomyopathy, whole-hearted enlargement, cardiac function level IV, right pleural effusion ), hypertension level 1 (very high risk), diabetes with serious complications (combined nephropathy, combined retinopathy, combined peripheral neuropathy) renal anemia and hypoproteinemia.
For the patient's condition, it was given anti-platelet aggregation, lipid regulation, plaque stabilization, anticoagulation, diuresis, vascular expansion, cardiac strengthening, slowing the ventricular rate, infusion of albumin to correct hypoproteinemia, neoactin improves cardiac function, small dose of levosimandan strengthening the heart, intravenous furosemide and torasemide for treatment. After the symptoms of heart failure have improved, it is recommended that the patient undergo coronary angiography to identify the vascular disease, but the patient refused this diagnosis and treatment measures because he was worried that the kidney damage would worsen and insisted on conservative treatment of the drug.
oral medications taken when discharged from the hospital are shown in Table 3.
Table 3 The treatment and follow-up of the patient with medication
Vilixigua:
After being discharged from the hospital, the patient was admitted to the Vilixigua Phase III VICTORIA study on March 29, 2018. The overall treatment process is shown in Table 4.
Table 4 Vilixigua treatment After
Vilixigua treatment, the patient's blood pressure was stable, and the dose was titrated every 2-3 weeks. After one month, the target dose was 10 mg qd, and it was maintained until the end of the study, with good tolerability.
Figure 1 The patient's blood pressure was stable during the treatment of Vilixigua
The patient's heart failure symptoms were significant when he was admitted to the group, and there was obvious edema of both lower limbs. He needed to sit in a wheelchair during follow-up visit. After half a year of treatment, the symptoms of edema of and heart failure were significantly improved. He could walk on his own and could participate in outdoor outings, which significantly improved his quality of life. During the trial period (one and a half years), no heart failure occurred and was hospitalized.
Expert comments
Professor Zhang Hong
This patient is a heart failure patient with multiple underlying diseases. He still has obvious symptoms of heart failure when enrolling, and he needs to be in a wheelchair during follow-up visit, and he has poor endurance for movement. After half a year of treatment with Weilixigua, the patient's heart failure symptoms improved significantly, his activity endurance was significantly improved, and he could follow up on his own, and his blood pressure was stable during the study period, and he did not have heart failure and was hospitalized again.
This case fully demonstrates the efficacy of Vilixigua in patients with heart failure with multiple comorbidities. In the case, this patient was hospitalized repeatedly due to heart failure and had a high demand for treatment, but after initial treatment, he still had obvious symptoms of heart failure after admission. He needs to formulate a discharge plan and follow-up plan according to his condition and risk, and drug optimization and adjustment as soon as possible.
analyzes the specific situation of the patient. He has a combination of hypertension, diabetes, diabetic nephropathy, renal anemia and other diseases. The condition is complicated, which leads to the complex use of drugs. Renal function, blood potassium and drug interactions must be considered when optimizing the treatment plan. The patient was given 2.5 mg qd treatment strictly according to the VICTORIA study plan, and the dose was titrated every 2-3 weeks, and the target dose was 10 mg qd after one month. During the overall treatment process of
, although the patient repeatedly suffered respiratory infection of due to poor basal constitution, he was still able to maintain the target dose of 10 mg qd of Weilixigua until the end of the study, and there was no interaction with other drugs during the treatment process, and the tolerance was good. This suggests that even for patients with heart failure who have multiple comorbidities and multiple comorbid medications, Vilixigua's good safety can still ensure that the patients receive sufficient treatment.
It should be emphasized that the reason why Vilixigu is still safe and sufficient in patients with multiple comorbidities is that Vilixigu is the main bioconversion pathway of 5'-diphosphate glucuronate transferase (UGT)-mediated glucuronide, which does not affect the activity of cytochrome P450 (CYP) enzyme, and has fewer pharmacokinetic interactions with heart failure and therapeutic drugs for comorbidity.
Overall, in the face of patients with heart failure with multiple comorbidities, Vilixigua can also show good efficacy and higher patient tolerance, which is of great significance to ensuring patient treatment and improving their prognosis. It should be emphasized that in addition to drug treatment, comprehensive management is also needed for patients with heart failure, such as establishing and improving the heart failure follow-up system and medical health records, strengthening patient education to improve their self-management ability and medication compliance, etc., to better improve patient prognosis.
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VICTORIA research [3] As the first innovative study specifically targeting the aggravated events of heart failure, it verified that the first sGC stimulator for heart failure, Vilixigua, can bring multiple benefits to the current unmet heart failure treatment by acting on the NO-sGC-cGMP pathway mechanism, thus opening a new era of joint management of multi-pathways in heart failure.
The results showed that after 10.8 months of median follow-up, compared with the placebo group, the absolute risk of cardiovascular death or first heart failure in patients in Vilixigua group was significantly reduced by 4.2%, and the number of cases required for treatment (NNT) = 24. In addition, the difference between the blood pressure changes and placebo is only 1-1.5 mmHg, and the incidence of adverse reactions such as anemia , dizziness, nausea, and headache is not different from that of placebo, and there is no need to monitor renal function and electrolytes, which is highly safe.
More than half of the patients enrolled in VICTORIA were estimated to have glomerular filtration rate (eGFR) of ≤60 ml/min/1.73 m2. Among them, patients with eGFR30 ml/min/1.73 m2 generally have worse conditions, more comorbidities, and higher baseline cardiac function classification and NT-proBNP values. However, regardless of the patient's eGFR at baseline, Vilicigua treatment achieved consistent benefits from the primary endpoint.
Vilixigua was approved for marketing in my country in May this year for patients with symptomatic chronic heart failure patients with ejection fraction (45%) after recent decompensation of heart failure after intravenous treatment. This has brought more benefits and more peace of mind to patients with heart failure with multiple comorbidities.
References:
[1]Sun Junyi, Xue Ruicong, Liang Weihao, Dong Xugang, Liu Chen. Current diagnosis and treatment status of chronic heart failure [J]. Journal of Nature, 2022, 44(02):126-148.
[2] Interpretation of key points of "China Cardiovascular Health and Disease Report 2020" [J]. Journal of China Cardiovascular, 2021, 26(03):209-218.
[3]Armstrong PW, et al. N Engl J Med. 2020;382(20):1883-1893.
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