[Modern pharmacotherapy in heart failure with reduced ejection fraction: is further improvement in prognosis...

A growing number of patients with chronic heart failure (CHF) is a combined result of aging and, paradoxically, the progress in management of cardiovascular diseases. The modern pharmacotherapy of HF with reduced ejection fraction (HFrEF) is based on the understanding of excessive neurohormonal activation as a key point in the pathophysiology and progression of HFrEF. The introduction of neurohormonal modifiers decreased significantly the mortality, survival and acute cardiac death rate. However, the rate of hospitalization increased and the quality of life is still poor. There is a large body of evidence on disease progression and mechanical heart failure as a main cause of death. The improvement in survival and decreasing the hospitalization rate remain a real challenge. The risk of death is the highest in the first weeks following hospitalization due to HF. The maintenance of stable patient condition is the priority of management. Pharmacotherapy at discharge should be optimized according to the prognostic factors to modify the clinical course of disease. Data from registries suggest that target doses are not reached and dose titration is not performed in outpatient clinics as it should be done according to guidelines. Taken together, the system of complex management of patients with HF focused on the management on discharge and early post-discharge period seems to be the best solution to identify the HF progression factors (suboptimal therapy, lack of revascularization, arrhythmia, concomitant diseases) and to improve the prognosis and the quality of life and to decrease the hospitalization rate.