[New pharmacologic therapies for chronic heart failure]
T Kempf1, U Bavendiek2, J Bauersachs2
1Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland. kempf.tibor@mh-hannover.de.
Der Internist
|June 28, 2017
Summary
New heart failure therapies are crucial. Proven strategies include managing hypertension and using SGLT2 inhibitors for type 2 diabetes, while sacubitril/valsartan shows promise for heart failure with reduced ejection fraction.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Heart failure presents a significant public health challenge due to high prevalence and incidence.
- There is a critical need for novel therapeutic strategies to prevent heart failure onset and mitigate associated morbidity and mortality.
Purpose of the Study:
- To review current and emerging therapeutic approaches for heart failure.
- To highlight effective strategies for heart failure prevention and management.
Main Methods:
- Review of existing literature on heart failure therapies.
- Analysis of evidence for specific drug classes and interventions.
Main Results:
- Optimized arterial hypertension therapy and SGLT2 inhibitor empagliflozin in type 2 diabetes are effective preventive strategies.
- Sacubitril/valsartan demonstrates superiority over ACE inhibitors in heart failure with reduced ejection fraction.
- Iron supplementation improves quality of life in iron-deficient heart failure patients with reduced systolic function.
Conclusions:
- While options for heart failure with preserved ejection fraction remain limited, advancements exist for reduced ejection fraction.
- Targeting lower serum concentrations of digitalis and considering iron supplementation are important clinical considerations.
Related Concept Videos
01:30Heart Failure V: Medical Management
419
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
419
01:22Heart Failure VI: Adjunct Therapies
466
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
466
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
1.3K
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
1.3K
01:22Heart Failure Drugs: β-Blockers
1.0K
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
1.0K
01:22Heart Failure Drugs: Diuretics
1.1K
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
1.1K
01:26Heart Failure Drugs: Inotropic Agents
1.7K
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
1.7K