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

Clinical Research in Cardiology, vol. 110, pp. 1150–1158

Abstract

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 theIfchannel 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 11

1. Amr Abdin corresponding

   Universitätsklinikum des Saarlandes

   Affiliation as printed

   Klinik Für Innere Medizin III-Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse 100, 66421, Homburg, Germany. amr.abdin@uks.eu

   Klinik Für Innere Medizin III-Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse 100, 66421, Homburg, Germany

2. Johann K Bauersachs

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany

3. Norbert Frey

   Heidelberg University

   Affiliation as printed

   Department of Internal Medicine III, University of Heidelberg, 69120, Heidelberg, Germany

4. Ingrid Kindermann

   Universitätsklinikum des Saarlandes

   Affiliation as printed

   Klinik Für Innere Medizin III-Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse 100, 66421, Homburg, Germany

5. Andreas Link

   Universitätsklinikum des Saarlandes

   Affiliation as printed

   Klinik Für Innere Medizin III-Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse 100, 66421, Homburg, Germany

6. Nikolaus Marx Aachen Department of Internal Medicine I (Cardiology)

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Internal Medicine I, Cardiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany

7. Mitja Lainščak
   Affiliation as printed

   Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia

8. Jonathan Slawik

   Universitätsklinikum des Saarlandes

   Affiliation as printed

   Klinik Für Innere Medizin III-Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse 100, 66421, Homburg, Germany

9. Christian M. Werner

   Universitätsklinikum des Saarlandes

   Affiliation as printed

   Klinik Für Innere Medizin III-Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse 100, 66421, Homburg, Germany

10. Jan Wintrich

    Universitätsklinikum des Saarlandes

    Affiliation as printed

    Klinik Für Innere Medizin III-Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse 100, 66421, Homburg, Germany

11. Michael Böhm

    Universitätsklinikum des Saarlandes

    Affiliation as printed

    Klinik Für Innere Medizin III-Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse 100, 66421, Homburg, Germany