Even up until last year, the bleak scenario regarding heart failure patients was that about half of them do not make it past the five-year mark. Now, a new drug on the scene is offering some hope.

The drug, Entresto, from pharmaceutical company Novartis, has been approved for use in Singapore by the Health Sciences Authority.

It received the nod after its successful worldwide trial from 2009 to 2013, which involved almost 50 countries and more than 8,000 heart failure patients.

Good results led researchers to end the trial after 27 months instead of the planned three years.

They found that the drug reduced the risk of cardiovascular death by 20 per cent compared to Enalapril, the current gold standard treatment for heart failure. It also reduced the likelihood of hospitalization for heart failure by 21 per cent.

Overall, the risk of death from any cardiovascular cause was cut by 20 per cent. What this means is that for every 1,000 patients who switch to the new drug, 31 can avoid death from cardiovascular causes.

“Even with existing drugs for chronic heart failure, the prognosis remains fairly poor. But this new drug reduces both mortality and morbidity. Some drugs reduce one but not the other, but this does both,” said Dr David Sim, Director, Heart Failure Programme, National Heart Centre Singapore (NHCS), and lead investigator for the study arm at NHCS.

The study involved 32 patients from NHCS and three other local hospitals.

According to Dr David Sim (centre in photo), the new drug reduces both mortality and morbidity. Some drugs reduce one but not the other.

How the new drug works
Entresto is meant for chronic heart failure patients with reduced ejection fraction (less than optimal percentage of blood pumped out by the heart with each heartbeat). It is not meant for patients who have advanced renal impairment or very low blood pressure.

The pill must be taken twice daily. It combines the following two compounds, which work differently to reduce the workload on a failing heart:

Valsartan – an existing drug which treats high blood pressure and heart failure. It allows blood vessels to relax and dilate, lowers blood pressure, and makes it easier for the heart to pump blood.

Sacubitril – the first in a new class of drugs, which prevents or delays the breakdown of naturally occurring natriuretic peptides. These peptides regulate fluid levels in the body and help protect the cardiovascular system from the negative effects of fluid overload.

“Essentially, one dampens the bad effects of a naturally occurring system in the body while the other enhances the beneficial effects of another system. So, overall, a yin-yang approach,” said Dr Sim.

By the numbers
• In 2015 alone there were more than 6,000 hospital admissions here due to heart failure.
• According to data, about 10% of those hospitalised die within 30 days.
• 1/5 need re-admission within the same period.
• In a healthy heart, 50% or more of total blood volume is being pumped by the heart ventricles with each heartbeat.

Types of heart failure
1) Heart failure with reduced ejection fraction (a suboptimal percentage of blood is pumped out by the heart with each heartbeat):

The left ventricle is not able to contract normally, indicating a pumping issue with less oxygenated blood getting to the rest of the body. Blood can enter the heart chamber but the heart muscle cannot pump out enough blood.

2) Heart failure with preserved ejection fraction (a normal percentage of blood is pumped out by the heart):

The left ventricle is not able to relax properly, indicating a filling problem as the heart chamber holds less blood than normal. Not enough blood enters the heart chamber but there is no problem pumping out whatever is there.

This story was first published in Singapore Health, Sep-Oct 2016 issue.