Heart failure medication and therapeutic approaches

Heart Failure Medication
The purpose of the article by Gordin and Fonarow (2016) entitled “New Medications for Heart Failure” is to examine and discuss established guidelines for medical treatment for heart failure. Specifically, the article examines pharmacological interventions for heart failure with regard to ACE inhibitors, beta blockers, aldosterone antagonists and reduced ejection fraction. It looks at recent studies that have allowed new therapeutic methods to be developed using ivabradine and valsartan, the former of which decreases heart rate and the latter of which elevates vasodilatory peptides that have an angiotensin receptor antagonist. The article was chosen because it is timely and evaluates the “first new-in-class medications” designed to further help provide quality care for patients suffering from heart failure (Gordin & Fonarow, 2016, p. 491). By examining several trials conducted for the drugs, the study shows that both ivabradine and valsartan are effective in decreasing hospitalizations for patients with heart failure. The trials referenced in the study include: the PARADIGM-HF trial, which found that valsartan helped to thwart the advance of heart failure much better than patients who were treated with enalapril; and the SHIFT trial, which showed that ivabradine improved heart failure patients’ quality of life, increased their ejection fraction, and reduced their end systolic and end diastolic volume indices.
The findings are consistent with and compare favorably to the conclusions of Bas, Baser and Nair (2017) who also note the FDA’s approval of the drugs and the new benefits they bring to patients suffering from heart failure, such as reduced hospitalization and improvements in quality of life. Gordin and Fonarow (2016) indicate that both ivabradine and valsartan may be used as part of a treatment plan for heart failure patients in the future for patients with heart rate at rest of 70 bpm or more. For the purposes of developing a treatment plan,t he study identifies the brand names of these drugs (Corlanor and Entresto, respectively), describes their FDA-approved purposes, the proper dosage for patients and associated goals, when to stop dosage, and the adverse side effects to watch out for, such as hypotension, renal impairment and cough for valsartan (Entresto) and hypertension, bradycardia and atrial fibrillation for ivabradine (Corlanor).
The implications of the article for nursing practice are that nurses should be able to decrease hospitalizations and improve quality of life for patients suffering from heart failure by using ivabradine or valsartan in their treatments. Such a pharmacological intervention could reduce rates of re-admittance and increase quality of care by alleviating problems associated with ejection fraction and ACE inhibitors. The significance of the study for heart failure research is that it shows how new breakthroughs in pharmacology are still possible but also that more work remains to be done in terms of obtaining still greater reductions in ejection fraction. Currently, the two drugs evaluated are primarily effective as beta blockers, ACE inhibitors and angiotensin receptor blockers. The strength of the article is that it describes in clear terms and minute detail (by evaluating the two main trials) why ivabradine and valsartan are effective. The weakness of the article is that it does not discuss any new recommendations for tests in experimental research and is only primarily a review of already published material. The article nonetheless impacted my practice by raising my awareness of what new drugs are effective for heart failure patients and when and why ivabradine and valsartan may be used in place of other drugs like enalpril. Further consideration should be given to assessing affects of these drugs on patients in my own practice to see whether this EBP bears out the positive findings of the study.

References
Bas, H. D., Baser, K., & Nair, N. (2017). Updates on management of advanced heart
failure. The Southwest Respiratory and Critical Care Chronicles, 5(20), 12-21.
Gordin, J. & Fonarow, G. (2016). New medications for heart failure. Trends in
Cardiovascular Medicine, 26, 485-492.