Emerging concepts in heart failure management and treatment: focus on current guideline-directed medical therapy for heart failure with reduced ejection fraction

Abstract

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 Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment

Investigación latinoamericana en falla cardiaca: análisis visual y bibliométrico de los últimos 20 años

“…Mientras que de 2003 a 2017 se estudiaron tópicos destinados a caracterizar, analizar e indagar sobre factores y patrones asociados a ciertas enfermedades cardiovasculares relacionadas con la falla cardíaca, en los últimos cinco años se ha intensificado la sistematización de datos y las pruebas de intervención para la resolución de la falla cardíaca. Este cambio es previsible, ya que después de un período significativo de producción de conocimiento sobre la población de interés, se busca sistematizar y calcular estimados que permitan determinar la precisión de una intervención y, finalmente, definir prácticas basadas en la evidencia aplicables a la población real (30)(31)(32) .…”