Vnitr Lek 2024, 70(2):102-106 | DOI: 10.36290/vnl.2024.021

Prevention of the development of advanced chronic heart failure - pharmacotherapy options

Monika ©pinarová, Jiří Vítovec, Lenka ©pinarová
I. interní kardioangiologická klinika LF MU a FN u sv. Anny, Brno

The treatment of chronic heart failure is always complex and includes both pharmacological and non-pharmacological procedures. However, the disease progresses to the end-stage of advanced heart failure in many patients, which is characterized by the persistence of symptoms despite maximal therapy. The basis of the treatment of patients with heart failure with reduced ejection fraction (HFrEF) are 4 pillars of drug groups: Angiotensin Receptor-Neprilysin Inhibitor (ARNI)/ Angiotensin-Converting Enzyme Inhibitors (ACEi), Beta blockers (BB), Mineralocorticoid receptor antagonist (MRA) and Sodium-glucose cotransporter-2 inhibitors (SGLT2i), which have mortality data from large randomized clinical trials. Their early use and rapid uptitration to the maximum tolerated dose is recommended. In addition, Sodium-glucose cotransporter-2 inhibitors SGLT2i are suitable for all heart failure patients regardless of ejection fraction value, and are also recommended for the treatment of Heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) patients. The treatment of comorbidities is also important, especially the treatment of anemia, where intravenous administration of iron carboxymaltose (FCM) already has its place. Patients with diabetes mellitus II. type and chronic kidney disease can benefit from treatment with finerenone. Tafamidis is recommended for patients with a genetically proven hereditary form of cardiac transthyretin amyloidosis and for patients with a wild-type form of cardiac transthyretin amyloidosis.

Keywords: heart failure, inhibition RAAS (ACEi, ARNI, MRA), betablockers, SGLT2, vericiguat, omecamtiv mecarbil, ferric carboxymaltose, tafamidis.

Accepted: March 26, 2024; Published: April 10, 2024  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
©pinarová M, Vítovec J, ©pinarová L. Prevention of the development of advanced chronic heart failure - pharmacotherapy options. Vnitr Lek. 2024;70(2):102-106. doi: 10.36290/vnl.2024.021.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 21. září 2021;42(36):3599-726.
    2. Málek F, Veselý J, Pudil R, et al. (Summary of 2021 ESC Guidelines for the diagnosis and treatment of heart failure). Cor Vasa. 26. duben 2022;64(2):121-62. Go to original source...
    3. McDonagh TA, Metra M, Adamo M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 1. říjen 2023;44(37):3627-39. Go to original source...
    4. Pitt B, Filippatos G, Agarwal R, et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 9. prosinec 2021;385(24):2252-63. Go to original source... Go to PubMed...
    5. Agarwal R, Filippatos G, Pitt B, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 10. únor 2022;43(6):474-84. Go to original source... Go to PubMed...
    6. McMurray JJV, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 11. září 2014;371(11):993-1004. Go to original source... Go to PubMed...
    7. Velazquez EJ, Morrow DA, DeVore AD, et al. Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med. 7. únor 2019;380(6):539-48. Go to original source... Go to PubMed...
    8. Wachter R, Senni M, Belohlavek J, et al. Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail. srpen 2019;21(8):998-1007. Go to original source... Go to PubMed...
    9. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 21. listopad 2019;381(21):1995-2008. Go to original source... Go to PubMed...
    10. Packer M, Anker SD, Butler J, et al. Effect of Empagliflozin on the Clinical Stability of Patients With Heart Failure and a Reduced Ejection Fraction: The EMPEROR-Reduced Trial. Circulation. 26. leden 2021;143(4):326-36. Go to original source... Go to PubMed...
    11. Bhatt DL, Szarek M, Steg PG, et al. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. N Engl J Med. 14. leden 2021;384(2):117-28. Go to original source... Go to PubMed...
    12. Voors AA, Angermann CE, Teerlink JR, et al. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med. březen 2022;28(3):568-74. Go to original source... Go to PubMed...
    13. Gheorghiade M, Greene SJ, Butler J, et al. Effect of Vericiguat, a Soluble Guanylate Cyclase Stimulator, on Natriuretic Peptide Levels in Patients With Worsening Chronic Heart Failure and Reduced Ejection Fraction: The SOCRATES-REDUCED Randomized Trial. JAMA. 1. prosinec 2015;314(21):2251-62. Go to original source... Go to PubMed...
    14. Armstrong PW, Pieske B, Anstrom KJ, et al. Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 14. květen 2020;382(20):1883-93. Go to original source... Go to PubMed...
    15. ©pinar J, ©pinarová L, Vítovec J. Vericiguat u nemocných se srdečním selháním a sníľenou ejekčí frakcí - studie VICTORIA. Vnitř Lékařství. 2021;67(3):180-2. Go to original source...
    16. Ezekowitz JA, O'Connor CM, Troughton RW, et al. N-Terminal Pro-B-Type Natriuretic Peptide and Clinical Outcomes: Vericiguat Heart Failure With Reduced Ejection Fraction Study. JACC Heart Fail. listopad 2020;8(11):931-9. Go to original source... Go to PubMed...
    17. Teerlink JR, Diaz R, Felker GM, et al. Effect of Ejection Fraction on Clinical Outcomes in Patients Treated With Omecamtiv Mecarbil in GALACTIC-HF. J Am Coll Cardiol. 13. červenec 2021;78(2):97-108. Go to original source... Go to PubMed...
    18. McDonagh T, Damy T, Doehner W, et al. Screening, diagnosis and treatment of iron deficiency in chronic heart failure: putting the 2016 European Society of Cardiology heart failure guidelines into clinical practice. Eur J Heart Fail. prosinec 2018;20(12):1664-72. Go to original source... Go to PubMed...
    19. Melenovský V, Táborský M, Linhart A, et al. Expertní konsenzus k významu deficitu ľeleza a moľnosti jeho korekce u pacientů se srdečním selháním. Vnitř Lékařství. 2021;67(8):495-7. Go to original source...
    20. Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†. Eur Heart J. 14. březen 2015;36(11):657-68. Go to original source... Go to PubMed...
    21. Ponikowski P, Kirwan BA, Anker SD, et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet Lond Engl. 12. prosinec 2020;396(10266):1895-904. Go to original source... Go to PubMed...
    22. Kalra PR, Cleland JGF, Petrie MC, et al. Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial. Lancet Lond Engl. 17. prosinec 2022;400(10369):2199-209. Go to original source... Go to PubMed...
    23. Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet Lond Engl. 3. prosinec 2022;400(10367):1938-52. Go to original source... Go to PubMed...
    24. ©pinarová M, ©pinar J, Pařenica J, et al. Preskripce a dávkování inhibitorů RAAS u pacientů s chronickým srdečním selháním v registru FAR NHL. Vnitř Lékařství. 2019;65(1):13-8. Go to original source...
    25. Lábr K, ©pinar J, Pařenica J, et al. Betablokátory v registru chronického srdečního selhání FAR NHL. Kardiologická Rev Interní Medicína. 2017;19(1):68-72.
    26. Solomon SD, McMurray JJV, PARAGON-HF Steering Committee and Investigators. Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. Reply. N Engl J Med. 19. březen 2020;382(12):1182-3. Go to original source...
    27. Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 22. září 2022;387(12):1089-98. Go to original source... Go to PubMed...
    28. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 14. říjen 2021;385(16):1451-61. Go to original source... Go to PubMed...

    Return to the content


    Vnitřní lékařství

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.