Pharmacists at the Center of Heart Failure Care: Navigating HFpEF and Finerenone Use – Pharmacy Times

Report on Advanced Management of Heart Failure and Alignment with Sustainable Development Goals

The increasing prevalence of Heart Failure with Preserved Ejection Fraction (HFpEF) presents a significant challenge to global public health, directly impacting the achievement of Sustainable Development Goal 3 (Good Health and Well-being). As a complex non-communicable disease (NCD), effective management of HFpEF is critical to meeting SDG Target 3.4, which aims to reduce premature mortality from NCDs. This report outlines the current treatment landscape, the role of pharmacists, and the potential of emerging therapies like finerenone in advancing patient care and health equity.

The Growing Burden of HFpEF and Its Impact on Health Systems

Epidemiological Overview

HFpEF constitutes a substantial and growing portion of cardiovascular disease cases, characterized by high rates of morbidity and hospitalization. Its management is complicated by frequent comorbidities, which underscores the need for integrated care approaches to address the broader challenge of NCDs.

• Accounts for up to 50% of all heart failure cases.
• Frequently associated with comorbidities such as diabetes, chronic kidney disease (CKD), hypertension, and obesity.
• Remains significantly underdiagnosed and undertreated, partly due to documentation gaps and lack of specialist oversight in non-cardiology settings.

Pharmacist-Led Interventions in Support of Universal Health Coverage (SDG 3.8)

Optimizing Guideline-Directed Medical Therapy

Pharmacists are integral members of the multidisciplinary care team, playing a crucial role in overcoming clinical inertia and ensuring patients receive evidence-based treatments. Their involvement directly supports the principles of SDG 3 by improving the quality of healthcare services.

• Pharmacists actively identify patients eligible for advanced therapies, including SGLT2 inhibitors and mineralocorticoid receptor antagonists (MRAs).
• They help educate non-cardiology providers on the benefits of these medications, framing them in the context of comorbidity management (e.g., renal or diabetes outcomes).
• Studies confirm that pharmacist involvement in heart failure management leads to significant improvements in medication optimization, adherence, and patient outcomes.

Ensuring Access to Affordable Medicines

A key component of SDG Target 3.8 is ensuring access to affordable essential medicines. Pharmacists are on the front lines of addressing financial and logistical barriers that prevent patients from obtaining necessary treatments.

• Pharmacists and dedicated teams manage prior authorization processes to secure insurance coverage for newer, more costly agents.
• These efforts successfully reduce patient out-of-pocket costs, mitigating financial risk and promoting equitable access to care.

Advances in Therapeutic Agents for Heart Failure

The Role of Mineralocorticoid Receptor Antagonists (MRAs)

MRAs are a cornerstone of heart failure therapy. The evolution from steroidal to nonsteroidal agents represents a significant advancement in treatment, offering improved safety and efficacy profiles.

1. Spironolactone: A nonselective, steroidal MRA associated with endocrine-related adverse effects like gynecomastia.
2. Eplerenone: A selective, steroidal MRA with fewer endocrine side effects.
3. Finerenone: A nonsteroidal MRA that has demonstrated both cardiovascular and renal benefits, making it a promising option for patients with comorbid CKD and diabetes.

Clinical Evidence for Finerenone

The FINEARTS-HF study demonstrated that finerenone effectively reduced the rate of heart failure aggravation in patients with HFpEF or HFmrEF. This evidence supports its use as an innovative tool to improve health outcomes, aligning with the goals of NCD management under SDG Target 3.4.

Managing Treatment Challenges to Ensure Patient Safety and Adherence

Hyperkalemia as a Barrier to MRA Therapy

A primary challenge limiting the widespread use of MRAs is the risk of hyperkalemia. Prescriber hesitancy due to this safety concern often prevents patients from receiving guideline-recommended therapy.

Pharmacist-Driven Mitigation Strategies

Pharmacists are essential in managing the risks associated with MRA therapy, thereby enabling more patients to benefit from these life-saving medications.

• Proactive monitoring of potassium levels.
• Strategic use of potassium binders, such as patiromer, to maintain MRA therapy long-term.
• Patient counseling on dietary and medication strategies to mitigate hyperkalemia risk.

Conclusion: Integrating New Therapies to Advance Global Health Goals

Pharmacists are critical drivers in improving the management of HFpEF and HFmrEF. By optimizing therapy, overcoming access barriers, and ensuring patient safety, they directly contribute to achieving Sustainable Development Goal 3. The successful integration of innovative treatments like finerenone, facilitated by the expertise of pharmacists, is essential for reducing the global burden of cardiovascular disease and advancing universal health coverage as outlined in SDG Target 3.8.

Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article focuses entirely on managing Heart Failure with Preserved Ejection Fraction (HFpEF), a non-communicable cardiovascular disease. It discusses treatment options, patient outcomes, and the role of healthcare professionals in improving care, which is central to SDG 3. The text mentions that HFpEF “is associated with high morbidity and hospitalization rates,” directly linking to the goal of ensuring healthy lives.

SDG 9: Industry, Innovation, and Infrastructure

• The development and clinical study of new medications like finerenone (Kerendia) represents scientific research and innovation within the pharmaceutical industry. The article references specific clinical trials such as the “TOPCAT trial” and the “FINEARTS-HF study,” which are prime examples of research and development aimed at creating new health technologies and treatments.

SDG 10: Reduced Inequalities

• The article highlights significant barriers to healthcare access, particularly related to cost. It states that pharmacists are involved in “navigating cost and access barriers” and that “prior authorizations and specialty pharmacy teams were essential to obtaining coverage.” This directly addresses the issue of inequality in access to essential medicines, a key concern of SDG 10.

What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment. The article’s focus on improving the management of heart failure, a major non-communicable disease, through advanced therapies like finerenone directly contributes to this target by aiming to reduce “high morbidity and hospitalization rates.”
• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines. The article details pharmacists’ efforts to overcome “cost and insurance approval challenges” and reduce “patient out-of-pocket costs,” which aligns with ensuring access to affordable essential medicines and providing financial risk protection.

SDG 9: Industry, Innovation, and Infrastructure

• Target 9.5: Enhance scientific research, upgrade the technological capabilities of industrial sectors in all countries… encouraging innovation. The discussion of finerenone as a “nonsteroidal MRA” that “provided cardiovascular benefits and renal effects” and the mention of the FINEARTS-HF study, which evaluated its efficacy, are direct results of the pharmaceutical industry’s investment in research and innovation to address unmet medical needs.

SDG 10: Reduced Inequalities

• Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality. The work of pharmacists in managing a “dedicated prior authorization process” to reduce costs for patients is a form of social protection within the healthcare system. This effort aims to ensure that access to newer, more effective treatments is not limited by a patient’s financial status, thereby reducing health inequalities.

Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

SDG 3: Good Health and Well-being

• Implied Indicator for Target 3.4: Mortality rate attributed to cardiovascular disease. The article mentions that HFpEF is associated with “high morbidity and hospitalization rates.” Reducing these rates through better treatment, as discussed, would be a measure of progress toward lowering mortality and morbidity from this NCD.
• Implied Indicator for Target 3.8: Proportion of population with large household expenditures on health as a share of total household expenditure or income. The article’s reference to pharmacists working to reduce “patient out-of-pocket costs” and navigate “cost and access barriers” implies that high costs are a significant burden, and measuring the reduction of this burden would indicate progress.

SDG 9: Industry, Innovation, and Infrastructure

• Implied Indicator for Target 9.5: Research and development expenditure as a proportion of GDP. The article’s focus on new drugs like finerenone and clinical trials like “FINEARTS-HF study (NCT04435626)” implies significant investment in R&D by pharmaceutical companies (e.g., Bayer HealthCare Pharmaceuticals Inc.) to bring innovative treatments to market.

SDG 10: Reduced Inequalities

• Implied Indicator for Target 10.4: Access rates to new medicines across different socioeconomic groups. The article highlights that “cost and insurance approval challenges limit uptake” of new drugs. Measuring the success of pharmacists’ interventions in securing “prior authorizations” and reducing costs would serve as an indicator of improved equity in accessing these therapies.

Table of SDGs, Targets, and Indicators

Source: pharmacytimes.com