Cross talk between patients and doctors

Cross talk between patients and doctors on ischemic heart disease: when real-world data meet real patients’ needs

Below are some of the most relevant ideas that were shared in the symposium, to enrich the reader's knowledge.

Despite having a relatively low prevalence within the general population (1 to 3%), Heart failure, has a high mortality at 5 years of follow-up. We must remember that the most prevalent etiology – about 50% – is ischemia, that chronically injures the myocardium, producing structural and functional maladaptations1.

We traditionally assume that ischemia is linearly associated with angina due to obstructed vascular vessels, and that it is linked a poor long-term prognosis, especially if revascularization is not achieved. But the multifactorial concept of angina is increasingly reinforced, without underestimating obstructive disease, but emphasizing the role of micro vessels, segmental alterations of flow and imbalance in the transport and delivery of oxygen2.

There is increasing evidence that by modifying the elements that unbalance the supply and demand of oxygen, which lead to clinical angina, it is possible to go beyond the relief or frequency reduction in symptoms and translate in a reduction of morbidity and mortality, as well as an improvement in the quality of life of heart failure patients with ischemic origin3.

Some findings from the new V-GOOD study, a multicenter observational study including 1,026 Brazilian patients with an established diagnosis of stable angina, symptomatic despite antianginal therapy, were also presented. The study showed that by adding Trimetazidine 80mg to the background treatment, these patients had significantly fewer angina attacks and fewer exercise limitations, with good treatment tolerance4.

This has been demonstrated over several years of data collection in randomized and real-life clinical trials5,6, with drugs such as Trimetazidine and Ivabradine, which became essential to consider within the optimal medical treatment of our patients with chronic coronary syndrome, especially if it has triggered heart failure.

Dr. César Gerardo López de la Vega, Cardiac rehabilitation cardiologist, Guatemala.

Referencias:

Banerjee A et a. EHJ HF 2022 ; 24 :466-80

Beltrame et al BMJ 2021; 375:e060602

Böhm et al. Clin Res Cardiol. 2013 ; 102 :1-12

Gowdak LHW et al ; V-GOOD investigators. 2023 (unpublished data) - Symposium Cross talk between patients and doctors on ischemic heart disease: when real-world data meet real patients’ needs, ESC Congress 2023

Eur J Heart Fail 2023 Apr 24. Doi: 10.1002/ejhf.2870

PENG S et al. The efficacy of trimetazidine on stable angina pectoris: a meta-analysis of randomized clinical trials Int J Cardiol. 2014; 177³:780-5

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