The encouraging evolution of a heart failure drug commercial.

In the mornings when I am doing my yoga/pilates/core exercises, my television is on in the background.  I also have the television on when I am researching and writing posts for the blog.  Maybe it is my imagination, but it seems as though the time devoted to commercials is becoming almost equivalent to the time devoted to programs. 

In my pre-heart failure days, I edited out the commercials in my head, or muted the sound.  My brain would have gone into its own world during the ads, and then when the program returned to the air, my brain would check back in.  But these days, for some reason, my brain more often checks out during the program and then checks back in when a health-related commercial appears.  
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You might be surprised as to how many drug commercials there are and the variety of medical conditions they cover.  The commercial I find most intriguing (for obvious reasons) is for the fairly recent heart failure drug known as Entresto.  This is because my doctors and I often discuss this drug, and they eventually may decide that this would be a good drug for me.  Accordingly, I want to know as much about the drug as possible.  So this post addresses why Entresto is so important for heart failure patients; the interesting evolution in the ads since the drug came on the market; and the manufacturer’s efforts to assist and empower heart failure patients.  I have specifically noticed over time how much more uplifting the content of the commercials have become. 

​In 2015, the Food and Drug Administration (FDA) approved Entresto.  The drug, manufactured by Novartis, treats chronic heart failure (Classes 2 through 4) and reduced ejection fraction.  A July 8, 2015 Washington Post article says the approval of the drug received unusually strong enthusiasm from the medical community.  The terms “blockbuster” and “breakthrough” were used in the article.

Why?  In a large trial composed of 8,442 patients, half the patients received Entresto and the other half received another heart failure drug.  Those on Entresto had a 20 percent reduction in risk of death or hospitalization.  This was such an unusual result that the FDA granted Entresto “fast track designation”.  What does this mean?  According to the FDA website, fast track is a process designed to facilitate development and expedite review of drugs that treat serious conditions and fill an unmet medical need. Fast track designation means that important new drugs can get to the patient earlier. 

So I think it is safe to call Entresto a potential heart failure wonder drug.  But as is the case with all drugs, Entresto has some notable side effects:  low blood pressure, high blood potassium levels, and poor function of the kidneys, and angioedema (meaning your lips and face swell).  Of course, if you listen to drug commercials, or if you read the drug package inserts, you will see that all drugs come with potential side effects.   Does this mean you will suffer any or all of the side effects?  No, but drug companies are required to give a full accounting of a drug and its impact.  (Note:  The reason my doctors must carefully weigh this drug for me include my already low blood pressure and my tendency to be a shade high in my potassium level).

I heard about Entresto from my doctors before I saw the first commercial related to Entresto.   Since that time, I recall three different Entresto-related ads, with each one becoming more upbeat and optimistic.  This tells me that the anecdotal data shows patients are indeed feeling and performing better with Entresto.

Let’s look at each commercial.  Shortly after Entresto was approved, Novartis released what in the medical world is referred to as a disease awareness ad campaign.  As I recall, the ad, entitled “Keep it pumping” did not mention Entresto.  Instead, you see a man sitting in his chair reading a newspaper with the television on while water slowly floods his living room.    You can hear the water flowing into the room.  The man’s dog is whining, seeking higher ground.  The man continues to read the paper, apparently oblivious to the fact that there is a heart failure issue that poses an imminent threat. 

The voice over warns:  "With heart failure, danger is always on the rise. Symptoms worsen because your heart isn't pumping well.  About 50% of people die within 5 years of getting diagnosed. But there's something you can do. Talk to your doctor about heart failure treatment options. Because the more you know the more likely you are to keep it pumping.”   Wow – what a downer!  I wonder how many people were on their doctors’ doorsteps immediately after seeing this ad.  According to the website Cardio Brief, Novartis took some on-line hits for the alarmist nature of this ad, even from heart failure experts who worked on the trial of Entresto. 

The first commercial that actually mentioned Entresto followed soon thereafter and was more uplifting – but still guarded probably because the company was in the process of gathering encouraging anecdotal support before declaring victory.  As is the case with every drug commercial, there is a familiar and distinctive song in the background.  In this case, it was the song “Tomorrow” from the play “Annie”. 

The commercial starts out showing several heart failure patients who are forced to postpone basic physical activities until tomorrow (if not beyond) because of their heart failure.  Then the action shifts to a patient talking with a doctor.  The narrator tells us about Entresto’s track record for improving patients' conditions and basically keeping patients alive.   The unspoken message is clear.  If you don’t take Entresto, there is no guarantee that you will ever be able to do more when tomorrow actually comes.   To prove the point, the next images you see show patients on Entresto who are more energetic and perform activities not just yesterday and today but conceivably for many more tomorrows to come.

Obviously the anecdotal data must have continued to be positive because the next commercial’s distinctive song is the Sonny and Cher hit, “The Beat Goes On.”  The lyrics and the melody underscore that the heart is beating more strongly and consistently.  The narrator tells viewers about a woman patient who is getting ready to cook dinner for ten – meaning obviously that she has the energy and drive to take on a very daunting task.  Then the narrator shows us a male patient.  And what task is the wonder drug strengthening his heart to take on?  Well he is about to go out on a date with his wife. 

Seriously?  Let’s be real - the woman is cooking an elaborate dinner!  Shouldn't the guy being performing some task of equivalent effort like changing the oil in the car or doing some yard work?  Instead, the guy is just walking with his wife, ordering and eating dinner, asking for the check and pulling out a credit card.  My first reaction was that maybe Novartis needed to rethink the message being sent by this commercial.

Then I saw the following April 2018 announcement from Novartis:  “Novartis today announced that JAMA Cardiology has published results from a post-hoc analysis demonstrating that treatment with Entresto® (sacubitril/valsartan) significantly improved seven out of 10 types of physical and social activities at eight months in heart failure patients with reduced ejection fraction (HFrEF) versus previous the standard of care.  The most significant improvements reported were in the ability to carry out household chores and the ability to conduct intimate/sexual relationships.”   So the commercial hits on both activities.  The fact that the male patient can go on a date with his wife must also be a celebration of this encouraging finding. 
 
Now here is something that surprised me.  The website PMLive says that the drug Entresto is tipped for blockbuster status but has so far performed better in Europe than in the United States.  In a July 2017 article on the website for Managed Care magazine Dr. William Chavey indicated one issue might be the 30-year experience that doctors had with the a drug used to treat heart failure known as ACE inhibitors.  Another might be that physicians are trying to figure out how the drug will interact with the other heart drugs patients take.  Chavey said “It is such a paradigm-changing drug that physicians want to be confident they are doing the right thing before they start prescribing it widely”.
 
Novartis is doing more than just trying releasing commercials about their product.  According to the website PMlive, Novartis has started a social network:  “It's a brave step for Novartis to compete with the likes of Facebook in setting up its own social network, but with nearly six million Americans having heart failure there is a sizable potential community it could attract.  Going beyond a simple peer-to-peer offer, the site also offers 'emotional support platforms' staffed by health researchers and clinicians.”  In my view, any tool or resources that Novartis can provide to help patients not only manage, but cope proactively with their heart failure, is an outstanding service to the heart failure community.

Finally, Novartis is offering an app for heart health which you can find in your app store.  It is called Heart Partner and appears to be a free app.  Here is the description:  “Heart Partner makes it easy to track daily vitals, store key health information, and coordinate care and activities with others.  It’s one app that offers two unique experiences based on whether you’re living with heart failure or are part of a Caregiver Support Team. “
 
One of the most onerous things about a chronic illness is keeping track of all the restrictions and rules, and applying them to your life.  So I like the image of patients, care-givers, and the medical industry partnering together so that tracking a patient’s heart failure becomes easy and the patient can then focus more on life’s rewards.
 
What does the future look like for heart failure patients?  If the anecdotal evidence shows good results with Entresto, and if doctors can figure out the optimal mix for each patients between Entresto and other drugs, I suspect sales will increase.   And I suspect the app Novartis created will be refined and increase the ability for patients and care-givers to track symptoms, treatment and progress.  
 
So the good news is that because of this drug and other heart related advances, the heart beat really will go on strong and steady.  When that happens, I think the theme song for the next Entresto commercial needs to be “Celebration” by Kool and the Gang.  And the heart failure patients in the commercial should be dancing joyfully and energetically.