Many heart failure patients could live much longer if they took a combination of newer drugs, study suggests.

The researchers estimate that if some heart failure patients were put on a four-pill regimen, including three recently proven treatments, they could live up to six years longer compared to the regimen patients typically use..

The results, published recently in the medical journal The Lancet, are predictions, not guarantees..

But they make a strong case for a cocktail of drugs, says lead author Dr. Mutiya Waduganathan, a cardiologist at Brigham and Women's Hospital in Boston..

“It is expected that the combined use of these four pills will allow patients not to visit the hospital and stay alive for several more years,” he said..

Heart failure is a chronic condition in which the heart muscle cannot pump blood efficiently enough to meet the body's needs, causing symptoms such as fatigue, shortness of breath, and leg swelling..

The new study focused on patients who had heart failure with reduced ejection fraction, which indicates how much blood the heart pumps out with each beat.. Decreased ejection fraction affects about half of patients with heart failure.

For a long time, the standard treatment regimen for these patients was a beta-blocker plus an ACE inhibitor or an angiotensin II receptor blocker (ARB).. All three drugs lower blood pressure and make the heart work easier through different mechanisms..

But more recently, clinical trials have shown that three other types of drugs can help patients live longer than standard drugs..

One is a drug called Entresto, which combines the ARB valsartan with another drug, sacubitril.. Another diabetes drug is called dapagliflozin (Farxiga), which has recently been shown to be helpful for heart failure patients with or without diabetes..

The third class of drugs is actually old: the mineralocorticoid receptor antagonists, which include spironolactone and eplerenone.. They help control blood pressure by blocking the hormone aldosterone..

Despite the positive results, many doctors are still not prescribing these drugs for heart failure, Vaduganathan said.. And there is little evidence of what will happen if patients use all three types of drugs..

“The optimal combination is really not explored,” Vaduganathan said..

So his team has tried to evaluate the benefits of sharing new treatments over the years.. To do this, they pooled short-term data from three large clinical trials that tested drugs against standard care.. They then made several predictions about what would happen if patients started taking a beta-blocker plus three classes of drugs instead of an ACE inhibitor or an ARB—and stuck to the regimen for the long haul.?

For a 55-year-old, this could mean an extra six years of life and eight years without hospitalization for heart failure, researchers think..

For 80-year-olds, the benefits would be smaller, but still important - on average, an extra year of life and almost three extra years out of the hospital.

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Thus, many patients may not be able to afford expensive medicines, even with insurance.. Minced meat costs about $500 for 30 tablets, while Entresto costs about $600 for 60 tablets, according to an online search..

Cost aside, not all patients need to be on medication. Walsh, who was not involved in the study, stressed that the results only apply to patients with reduced ejection fraction, which excludes half of people with heart failure..

And any patient, according to her, may have other health problems that are contraindicated for this drug..

" “But that shouldn’t stop patients from asking questions of the doctor.”.

In particular, she says, patients who are still on an ACE inhibitor or an ARB can ask their doctor why they weren't switched to Entresto - which in the guidelines is the preferred choice..

Vaduganathan noted that Farsig's diabetes has just been approved for the treatment of heart failure with reduced ejection fraction.. Thus, it is not yet included in treatment recommendations..

The study did not receive funding, but researchers report links to various pharmaceutical companies producing heart failure drugs..

medical-heal. en.