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What do the new ESC Guidelines for the treatment of heart failure bring to internists?

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec

    Vnitrni Lekarstvi
    |October 8, 2022
    PubMed

    Insights

    Managing chronic heart failure in Europe requires adhering to guidelines. Patients need four key drug classes—ACE inhibitors/ARNI, beta-blockers, MRA, and SGLT2 inhibitors—titrated gradually for optimal outcomes.

    Area of Science:

    • Cardiology
    • Public Health
    • Pharmacology

    Background:

    • Chronic heart failure (CHF) affects 0.4-2.0% of the European population, with prevalence increasing with age.
    • Improved acute care has led to a rise in CHF patients, posing significant management challenges.
    • CHF is associated with a poor prognosis and demanding diagnostic and therapeutic approaches.

    Purpose of the Study:

    • To emphasize the importance of guideline-adherent pharmacotherapy in managing chronic heart failure.
    • To highlight the recommended drug classes for CHF treatment according to European guidelines.
    • To outline the strategy for stepwise drug administration and dose titration in CHF patients.

    Main Methods:

    • Review of European Society of Cardiology (ESC) guidelines for heart failure diagnosis and treatment.
    • Analysis of recommended pharmacotherapy classes for CHF management.
    • Description of a step-by-step approach for drug initiation and dose titration.

    Main Results:

    • European guidelines mandate the use of four drug classes with Class 1 recommendation for CHF: ACE inhibitors/Angiotensin Receptor-Neprilysin Inhibitors (ACEI/ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors.
    • These medications should be administered at recommended doses.
    • A phased, step-by-step approach with dose titration is crucial for effective treatment.

    Conclusions:

    • Adherence to European guidelines for CHF management is critical.
    • Comprehensive pharmacotherapy involving ACEI/ARNI, beta-blockers, MRA, and SGLT2 inhibitors is essential.
    • Systematic dose titration of these medications is key to improving patient outcomes in chronic heart failure.

    Keywords:
    chronic heart failurediagnosistreatmenttype 2 diabetes

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