Timely and individualized heart failure management: need for implementation into the new guidelines.
Amr AbdinJohann BauersachsNorbert FreyIngrid KindermannAndreas LinkNikolaus MarxMitja LainscakJonathan SlawikChristian WernerJan WintrichMichael BöhmPublished in: Clinical research in cardiology : official journal of the German Cardiac Society (2021)
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.
Keyphrases
- heart rate
- heart failure
- acute heart failure
- ejection fraction
- primary care
- left ventricular
- healthcare
- heart rate variability
- end stage renal disease
- quality improvement
- iron deficiency
- chronic kidney disease
- risk factors
- cardiac resynchronization therapy
- atrial fibrillation
- type diabetes
- stem cells
- coronary artery disease
- risk assessment
- skeletal muscle
- case report
- peritoneal dialysis
- sleep quality
- binding protein
- drug induced
- amino acid