INTRODUCTION

Heart failure (HF) remains a significant global health issue, affecting approximately 64 million individuals worldwide. In the Philippines, the prevalence aligns with global estimates, disproportionately affecting older populations.

METHODOLOGY

The Philippine National Heart Failure Network (PNHFN) conducted a cross-sectional survey from November 2021 to March 2022 to assess the landscape of HF management among medical professionals across the country.

RESULTS

A total of 1,649 physicians responded, primarily cardiologists (64%), internal medicine specialists (27%), and general practitioners (12%). While diagnostic tools such as electrocardiography (92%) and 2D echocardiography (85%) were widely available, advanced imaging modalities and specialized cardiac procedures, including cardiac catheterization and heart failure implantable devices, were less accessible outside metropolitan areas. Essential HF medications, including renin-angiotensin system blockers (84%), beta-blockers, and diuretics, were commonly prescribed; however, newer pharmacologic options such as sodium-glucose co-transporter 2 inhibitors remained underutilized.

CONCLUSION

Cardiac rehabilitation was accessible to less than half of respondents (48%), with unavailability cited as a major barrier. Despite these challenges, 97% of participants supported the establishment of HF programs to improve patient care and provider support. The findings highlight the need for improved access to advanced diagnostic and therapeutic modalities, enhanced education on guideline-directed HF management, and expanded infrastructure to bridge gaps in care delivery. Strengthening national HF initiatives and fostering collaboration among stakeholders are crucial in optimizing HF management and patient outcomes in the Philippines.

Human ; Heart Failure ; Philippines ; Healthcare Infrastructure ; Public Health Infrastructure

BACKGROUND: Sacubitril/valsartan is currently a standard medication in the treatment of reduced ejection fraction heart failure (HFrEF), and studies have also shown its efficacy for controlling hypertension. However, its efficacy varies between populations, and current recommendations are predominantly based on non Asian data. Hence, this study synthesizes the available evidence to determine its overall efficacy and safety among Asians. METHODS: A systematic search through PubMed, ScienceDirect, Cochrane, HERDIN PLUS, and ClinicalTrials.gov was done to include randomized controlled trials with Asian data comparing sacubitril/valsartan against an active control. The Cochrane Risk of Bias 2.0 was used to assess each article for bias. Forest plots in fixed-effects model for major adverse cardiovascular events (MACEs), hypertension control, and safety were created using RevMan 5.4. RESULTS AND DISCUSSION: Ten articles with an overall low risk of bias were included involving 6120 Asians. Sacubitril/valsartan showed better hypertension control against conventional angiotensin blocker (odds ratio [OR], 1.63; confidence interval [CI], 1.38–1.92; I2 = 7%). However, MACE reduction was not significant in HFrEF (hazard ratio, 0.89; CI, 0.73–1.08; I2 = 0%) or acute myocardial infarction (hazard ratio, 0.90; CI, 0.65–1.24; I2 = 0%). Safety was comparable to conventional angiotensin-converting enzyme inhibitors angiotensin receptor blocker (ARB) with a severe adverse event OR of 0.81 (CI, 0.44–1.50; I2 = 38%) and nonsevere adverse event OR of 1.09 (CI, 0.88–1.35; I2 = 44%). These results implicate the nee for efficacy studies focused on Asians, reassessment of the strength of recommendations in the treatment of heart failure, and consideration of sacubitril/valsartan as a treatment option for hypertension. CONCLUSION Among Asians, better hypertension control is seen with LCZ696 than conventional ARB. However, MACE reduction in HFrEF or acute myocardial infarction is insignificant, although there is a trend toward benefit. Finally, safety is comparable to conventional angiotensin-converting enzyme inhibitors/ARBs.\.
Asian ; Heart Failure ; Hypertension ; LCZ696 ; sacubitril and valsartan sodium hydrate drug combination