Quick answer: Heart failure care has been transformed over the last decade. Two new drug classes — SGLT2 inhibitors and ARNI — have joined the ‘four pillars’ of treatment, and many patients with severely weakened hearts can now see their heart function return to near-normal on scans, reversing what used to be considered an irreversible, poor-prognosis condition.
Originally written in October 2025.
At medical school, we were encouraged to spend a few months abroad on what was called an ‘elective’, to experience healthcare in a different setting. Many students went to America to see cutting edge medicine, or Africa to help in remote villages. In 1998, I set off for St Vincent & the Grenadines in the Caribbean. Whilst the islands of the Grenadines are a millionaire’s paradise playground, St Vincent itself was incredibly poor. HIV was rife, the hospital had few facilities and even less equipment. As a medical student I was surplus to requirements in a clinical sense, but witnessed a lot of trauma in A&E and on the wards, although incredible kindness too. I stayed in the nurses residential block; very simple accommodation, with a hosepipe for a shower. I have many vivid memories from those months, but one that came back to me this week was from a few weeks in. I was sat on the porch of the accommodation, a glass of incredibly rough rum in hand (I never did get the taste for rum!) and thought to myself, ‘this is what it is like to have nothing on my agenda’. I had never considered myself stressed, in fact my wife says I’m one of the most laid back people she knows, but the absence of stuff I had to do really hit home. This was of course before I had a mobile phone. Internet was dial up if even available. I had a book, some cards, and some rum. I had been working incredibly hard at University, studying for exams, and it was only when I stopped that I realised I really needed to decompress.
This week I am on holiday, and the sense of déjà vu a few days in did not escape me. I’m a 100% sort of person, which often serves me well, and certainly helps ‘getting stuff done’. In my professional life it helps with innovating, improving medical services, managing my team and getting my blog done each week; in my personal life it helps commit to healthy habits like exercise and nutrition. It does not, however, help with time management, and the older I get, the less of that I seem to have. Life is always so busy, every minute crammed with something. Often something ‘important’ but crammed nonetheless. It’s only in the holidays I stop and reflect how busy I am, but then always seem to get back, nice and refreshed, and start the whole treadmill all over again. I expect I am not alone in this affliction, and I certainly don’t have any answers, but I am grateful for being in the midst of a lovely family holiday where every minute is not planned.
Back to my mini series: if you’ve missed the last few weeks, I recently passed my decade milestone as a consultant cardiologist in Bournemouth, and am writing a few posts reflecting on the best developments in heart health that time.
Let’s talk Heart Failure, and what a decade it has been!
Why has heart failure treatment historically been so poor?
They are a horrible two words, heart failure. In the UK it is thought there are one million people living with heart failure, and so it is incredibly common. Chances are you know someone who has it, or who has died from it. I’ve done lots of posts and videos about heart failure which I won’t repeat here outlining the causes, diagnosis and so on, (you can see these in the website members area) but what I do want to highlight is how well it can be treated with modern therapy.
The connotations are surely a rapid demise? Irreversible?
Wrong.
The main reason I developed a specialist interest in heart failure was that it annoyed me that even in the mid 2000s when I was training, there were some good medicines that simply weren’t being used. Many doctors were either ignorant of the drugs or unwilling to try them, and as such, outcomes were awful. Worse than virtually all cancers in terms of death risk. I wanted to change that as best I could.
What are the ‘four pillars’ of heart failure treatment?
Fast forward to 2025, and we have the ‘4 pillars’ of heart failure care. Many patients who have severe impairment of function can be improved to the point of cure – their hearts are indistinguishable on scans from normal. In fact, my cardiac radiology colleagues regularly comment to me how they never cease to be amazed at the improvements in heart function on patient scans they see since we have had these drugs in the heart failure unit, something they simply didn’t see a decade ago. Two of these pillars have been added in the last ten years:
What is a SGLT2 inhibitor?
• SGLT2 Inhibitors (Empagliflozin, Dapagliflozin)
These drugs deserve special mention as they are the first drug class in years to reduce mortality and hospitalisation across both types of heart failure, irrespective of diabetes status.
What is ARNI?
• ARNI (Sacubitril/Valsartan)
This drug has largely replaced older drugs such as ACE inhibitors (often end in -pril) and ARBs (often end in -sartan) in my clinic.
I can’t overstate how rewarding it is when I see I patients for follow up after starting the optimum drugs, whose symptoms disappear or hugely improve and they get their life back.
The extra years they get to spend with their loved ones.
I would also like to give a special mention to my team in hospital and the heart failure specialist nurses in the community. I certainly can’t see every heart failure patient, and without their expertise and diligence the great outcomes we now see simply wouldn’t be possible. Thank you.
There are a number of other innovations in the world of heart failure over the last decade, and indeed some other medications but these two above really have changed the landscape. I will discuss some of the technological advances in next week’s blog post.
In this week’s research video, I discuss the latest evidence on anti-depressant medication and the heart (apologies in advance if the recording quality isn’t as good as usual, it is recorded from my hotel and finding a suitable spot that wasn’t too noisy was challenging!)