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Pharmacological management of chronic heart failure

Michel Komajda1

  • 1Département de cardiologie, hôpital universitaire La Pitié-Salpêtrière, Paris, France.

La Revue Du Praticien
|December 5, 2018
PubMed

Insights

Managing chronic heart failure (CHF) involves specific drug classes for heart failure with reduced ejection fraction (HFrEF) to improve survival. However, treatments for heart failure with preserved ejection fraction (HFpEF) primarily reduce hospitalizations, not mortality.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Context:

  • Chronic heart failure (CHF) is a widespread condition with significant mortality and hospitalization rates.
  • Heart failure management strategies differ significantly between reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) subtypes.

Purpose:

  • To review the current pharmacological management of chronic heart failure (CHF).
  • To outline evidence-based treatments for HFrEF and HFpEF.
  • To identify unmet needs in CHF treatment, particularly regarding hospitalization burden.

Summary:

  • For HFrEF, six drug classes (ACE inhibitors, beta-blockers, MRAs, ARBs, ivabradine, sacubitril-valsartan) are proven to reduce mortality and morbidity.
  • In HFpEF, no drug has convincingly shown mortality benefits, though spironolactone can decrease HF hospitalizations.
  • Disease-modifying drugs have reduced heart failure-related mortality, but hospitalizations remain a challenge.

Impact:

  • Provides a clear overview of current guideline-directed medical therapies for CHF subtypes.
  • Highlights the therapeutic gap in HFpEF, emphasizing the need for novel treatment strategies.
  • Underscores the ongoing challenge of managing hospitalizations and rehospitalizations in chronic heart failure patients.

Keywords:
heart failuretherapeutic

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