Timely and individualized heart failure management: need for implementation into the new guidelines.

Abstract

Due to remarkable improvements in heart failure (HF) management over the last 30 years, a significant reduction in mortality and hospitalization rates in HF patients with reduced ejection fraction (HFrEF) has been observed. Currently, the optimization of guideline-directed chronic HF therapy remains the mainstay to further improve outcomes for patients with HFrEF to reduce mortality and HF hospitalization. This includes established device therapies, such as implantable defibrillators and cardiac resynchronization therapies, which improved patients' symptoms and prognosis. Over the last 10 years, new HF drugs have merged targeting various pathways, such as those that simultaneously suppress the renin-angiotensin-aldosterone system and the breakdown of endogenous natriuretic peptides (e.g., sacubitril/valsartan), and those that inhibit the If channel and, thus, reduce heart rate (e.g., ivabradine). Furthermore, the treatment of patient comorbidities (e.g., iron deficiency) has shown to improve functional capacity and to reduce hospitalization rates, when added to standard therapy. More recently, other potential treatment mechanisms have been explored, such as the sodium/glucose co-transporter inhibitors, the guanylate cyclase stimulators and the cardiac myosin activators. In this review, we summarize the novel developments in HFrEF pharmacological and device therapy and discuss their implementation strategies into practice to further improve outcomes.

• Authors: Amr Abdin, Johann Bauersachs, Norbert Frey, Ingrid Kindermann, Andreas Link, Nikolaus Marx, Mitja Lainscak, Jonathan Slawik, Christian Werner, Jan Wintrich, Michael Böhm
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 110 Issue 8 Pg. 1150-1158 (Aug 2021) ISSN: 1861-0692 [Electronic] Germany
• PMID: 33983472 (Publication Type: Journal Article, Review)
• Copyright: © 2021. The Author(s).

Chemical References

• Cardiovascular Agents

Topics

• Cardiac Resynchronization Therapy (trends)
• Cardiovascular Agents (therapeutic use)
• Comorbidity
• Heart Failure (therapy)
• Humans
• Practice Guidelines as Topic
• Precision Medicine
• Renin-Angiotensin System (drug effects)