Pharmaco-refractory chronic heart failure--the need for drug level tailored management

Pharmacorefractory chronic heart failure is a serious world-wide problem of systolic dysfunction not improving despite evidence based chronic heart failure pharmacotherapy. With the aim to reverse the poor pharmacorefractory chronic heart failure prognosis, severe sophisticated technical therapeutic approaches (from cardiac resynchronization usually with implantable cardioverter-defibrillator to heart transplantation) have been clinically adopted and detached at least for the most eligible pharmacorefractory chronic heart failure patients. However, both significant limitations of these highly specialised therapeutic techniques (cost, uncertain individual effect, complication, adverse effect, waiting list) and the pharmacorefractory chronic heart failure hopelessness for unfit patients make the effort to stop the pharmacorefractory chronic heart failure genesis never ending longing. Regarding growing knowledge on differences in pharmacokinetics, authors assume that the relative undertreatment despite fixed doses may explain the pharmacorefractory chronic heart failure genesis. If this hypothesis proves to be correct, the evidence based chronic heart failure pharmacotherapy innovatively personalized according to steady state drug serum level may reduce the pharmacorefractory chronic heart failure epidemiology with the lower need for cost-consuming techniques and be the promising strategy for patients left on individually ineffective evidence based chronic heart failure pharmacotherapy.