[European guidelines on heart failure: pharmacotherapy]

Area of Science:

• Cardiology
• Pharmacotherapy
• Clinical Practice Guidelines

Context:

• The European Society of Cardiology (ESC) released new 2021 guidelines for heart failure management.
• Traditional step-by-step treatment algorithms have been revised.
• Focus shifted towards pharmacotherapy strategies.

Purpose:

• To outline the fundamental revisions in heart failure pharmacotherapy based on the 2021 ESC guidelines.
• To highlight the recommended early treatment approach for heart failure with reduced ejection fraction (HFrEF).

Summary:

• For patients with HFrEF (ejection fraction ≤40%), the guidelines recommend early initiation of four major drug classes: angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor-neprilysin inhibitors (ARNI), beta blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose transporter 2 (SGLT2) inhibitors.
• The strategy emphasizes completing these four substance groups as early as possible post-diagnosis.
• Priority is given to the combination of these drug classes rather than escalating the dosage of individual agents.

Impact:

• This revised approach necessitates a re-evaluation of current clinical practices in heart failure management.
• The guidelines' reluctance to provide concrete implementation instructions presents a challenge for clinicians.
• Potential for improved patient outcomes through early, comprehensive pharmacotherapy in HFrEF.