Emerging concepts in heart failure management and treatment: focus on current guideline-directed medical therapy for heart failure with reduced ejection fraction.
ARNi
MRA
SGLT2i
angiotensin II receptor-neprilysin inhibitor
dapagliflozin
empagliflozin
glucose cotransporter 2 inhibitors
glucose cotransporter type 2 inhibitors
heart failure
mineralocorticoid receptor antagonists
sacubitril/valsartan
sodium
Journal
Drugs in context
ISSN: 1745-1981
Titre abrégé: Drugs Context
Pays: England
ID NLM: 101262187
Informations de publication
Date de publication:
2023
2023
Historique:
received:
26
06
2022
accepted:
20
09
2022
entrez:
20
1
2023
pubmed:
21
1
2023
medline:
21
1
2023
Statut:
epublish
Résumé
One of the most relevant and differentiating aspects provided by the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure is the retraction of the historical stepped and vertical pharmacological treatment scheme for heart failure with reduced ejection fraction (HFrEF). Subsequently, it was replaced by an updated algorithm that places four therapeutic families in the same initial horizontal step with an equally high degree of recommendation (class I). In this context, these four pillars, which have demonstrated a significant reduction in mortality and hospitalizations in patients with HFrEF, include (1) angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB)/angiotensin II receptor-neprilysin inhibitors (ARNi), (2) beta blockers, (3) mineralocorticoid receptor antagonists (MRA) and (4) sodium-glucose cotransporter 2 inhibitors (SGLT2is) as the main novelty. This manuscript reviews the current therapeutic algorithm with a special focus on the therapeutic value of adding an MRA (still underused in both clinical trials and real world), changing an ACEi/ARB for an ARNi and incorporating an SGLT2i in patients with HFrEF. This article is part of the
Identifiants
pubmed: 36660017
doi: 10.7573/dic.2022-6-4
pii: dic-2022-6-4
pmc: PMC9828867
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Informations de copyright
Copyright © 2023 Ospina González OE, Llanos Mejía DC, Kaplinsky E, Barbagelata A, Perrone S.
Déclaration de conflit d'intérêts
Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/10/dic.2022-6-4-COI.pdf
Références
Eur J Heart Fail. 2021 Jun;23(6):1040-1048
pubmed: 33847047
Hellenic J Cardiol. 2022 Jul-Aug;66:72-79
pubmed: 35508296
N Engl J Med. 2020 Oct 8;383(15):1413-1424
pubmed: 32865377
Eur J Heart Fail. 2016 Apr;18(4):402-10
pubmed: 26754527
Nat Med. 2022 Mar;28(3):568-574
pubmed: 35228754
Eur J Heart Fail. 2016 Aug;18(8):891-975
pubmed: 27207191
JAMA. 2019 Sep 17;322(11):1085-1095
pubmed: 31475295
Eur J Heart Fail. 2018 Sep;20(9):1326-1334
pubmed: 29578280
Eur J Heart Fail. 2013 Oct;15(10):1173-84
pubmed: 23978433
N Engl J Med. 2014 Sep 11;371(11):993-1004
pubmed: 25176015
Diabetes Ther. 2021 Jan;12(1):55-70
pubmed: 33185854
Diabetes Obes Metab. 2016 Aug;18(8):783-94
pubmed: 27059700
Eur Heart J. 2014 Feb;35(7):419-25
pubmed: 24227810
JAMA Cardiol. 2022 Jan 1;7(1):17-25
pubmed: 34730769
Circulation. 2019 Mar 12;139(11):1354-1365
pubmed: 30586756
JACC Heart Fail. 2022 Feb;10(2):73-84
pubmed: 34895860
N Engl J Med. 2019 Feb 7;380(6):539-548
pubmed: 30415601
N Engl J Med. 2003 Apr 3;348(14):1309-21
pubmed: 12668699
J Am Coll Cardiol. 2021 Mar 23;77(11):1397-1407
pubmed: 33736821
N Engl J Med. 1999 Sep 2;341(10):709-17
pubmed: 10471456
Cardiovasc Ther. 2018 Oct;36(5):e12459
pubmed: 30019390
Eur J Heart Fail. 2019 Aug;21(8):998-1007
pubmed: 31134724
JACC Heart Fail. 2014 Dec;2(6):663-70
pubmed: 25306450
JAMA. 2019 Sep 17;322(11):1077-1084
pubmed: 31475296
N Engl J Med. 2011 Jan 6;364(1):11-21
pubmed: 21073363
N Engl J Med. 2021 Oct 14;385(16):1451-1461
pubmed: 34449189
Eur Heart J. 2021 Sep 21;42(36):3599-3726
pubmed: 34447992
Front Cardiovasc Med. 2021 May 21;8:676658
pubmed: 34095263
N Engl J Med. 2021 Jan 14;384(2):117-128
pubmed: 33200892
J Clin Pharmacol. 2010 Apr;50(4):401-14
pubmed: 19934029
Cardiovasc Diabetol. 2018 Jul 10;17(1):101
pubmed: 29991346
N Engl J Med. 2019 Nov 21;381(21):1995-2008
pubmed: 31535829
Eur Heart J. 2021 Feb 11;42(6):681-683
pubmed: 33447845
Lancet. 2020 Jul 11;396(10244):121-128
pubmed: 32446323
N Engl J Med. 2022 Sep 22;387(12):1089-1098
pubmed: 36027570
Nephron Physiol. 2006;103(3):p149-56
pubmed: 16582578
Eur Heart J Suppl. 2019 Feb;21(Suppl A):A55-A60
pubmed: 30837806
JACC Heart Fail. 2021 Apr;9(4):254-264
pubmed: 33549554