Vnitr Lek 2023, 69(2):82-87 | DOI: 10.36290/vnl.2023.015
New perspectives in the treatment of chronic heart failure
- Centrum preventivní kardiologie, II. interní klinika LF a FN v Plzni, UK v Praze
The most recent guidelines on heart failure of the European Society of Cardiology were published in 2021. These guidelines devide patients according to the ejection fraction of the left ventricle into the group with reduced, mildly reduced and preserved ejection fraction. The guidelines follow the recent evidence based medicine and clinical studies in their recommendations. A novel group of drugs aiming to reduce morbidity and mortality and to improve the quality of life in patients with reduced ejection frations are SGLT2 inhibitors - gliflozins. The guidelines of the American Society of Cardiology set the treatment by gliflozins regardless of ejection fracion. The guidelines point out the treatment of comorbidities like diabetes, iron deficiency or tumors. A complex approach of patients with heart failure including heart failure clinics is presented.
Keywords: ejection fraction, guidelines, heart failure, SGLT2 inhibitors.
Accepted: March 23, 2023; Published: March 30, 2023 Show citation
References
- McDonagh TA, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 doi: 10.1093/eurheartj/ehab368.
Go to original source...
Go to PubMed...
- Špinar J, Špinarová L, Vítovec J. Co internistům přinášejí nová doporučení ESC pro léčbu srdečního selhání 2021? Vnitř Lék. 2022;68(2):104-110.
- Heidenreich PA, Bozkurt B, Aguilar D, el al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79:1757-1780.
Go to original source...
- McMurray JJ, Packer M, Desai AS, et al. PARADIGM‑HF Investigators and Committees. Angiotensin‑neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993-1004.
Go to original source...
- Seferovic JP, Claggett B, Seidelmann SB, et al. Effect of sacubitril/valsartan versus enalapril on glycaemic control in patients with heart failure and diabetes: a post‑hoc analysis from the PARADIGM‑HF trial. Lancet Diabetes Endocrinol. 2017;5:333-340.
Go to original source...
Go to PubMed...
- Damman K, Gori M, Claggett B, et al. Renal effects and associated outcomes during angiotensin‑neprilysin inhibition in heart failure. JACC Heart Fail 2018;6:489-498.
Go to original source...
- Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta‑analysis of cardiovascular outcome trials. Lancet 2019;393(10166):31-39.
Go to original source...
- McMurray JJV, Solomon SD, Inzucchi SE, et al. [DAPA‑HF Trial Committees and Investigators]. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008.
Go to original source...
- Packer M, Anker SD, Butler J, et al. [EMPEROR‑Reduced Trial Investigators]. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020;383(15):1413-1424.
Go to original source...
- Zannad F, Ferreira JP, Pocock SJ, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta‑analysis of the EMPEROR‑Reduced and DAPA‑HF trials. Lancet. 2020;396(10254):819-829.
Go to original source...
- Prázný M. SGLT-2 inhibitory a jejich uplatnění v praxi - update 2022. Vnitř Lék. 2022;68(2):96-103.
Go to original source...
Go to PubMed...
- Armstrong PW, Pieske B, Anstrom J, et al. Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2020;382:1883-1893. DOI: 10.1056/NEJMoa1915928.
Go to original source...
Go to PubMed...
- Špinar J, Špinarová L, Vítovec J. Vericiguat u nemocných se srdečním selháním a sníženou ejekčí frakcí - studie VICTORIA. Vnitř Lék. 2021;67(3):180-182.
Go to original source...
Go to PubMed...
- Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med 2021;385:1451-1461 DOI: 10.1056/NEJMoa2107038.
Go to original source...
Go to PubMed...
- Scott D. Solomon SD, McMurray JVV, Claggett B, el al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction N Engl J Med. 2022;387:1089-1098. DOI: 10.1056/NEJMoa2206286.
Go to original source...
Go to PubMed...
- Vaduganathan M, Docherty KF, Claggett FL, et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta‑analysis of five randomised controlled trials. Lancet. 2022;400:757-767. Available from: https://doi.org/10.1016/S0140-6736(22)01429-5.
Go to original source...
Go to PubMed...
- Haluzík M, Kubíčková M, Veselý J, el al. Expertní konsenzus k praktickým aspektům spolupráce kardiologa a diabetologa v péči o pacienty s chronickým srdečním selháním s redukovanou ejekční frakcí. Vnitř Lék. 2021;67(7):404-410.
Go to original source...
Go to PubMed...
- Viklický O, Ryšavá R, Tesař V, el al. Expertní stanovisko ke spolupráci diabetologů a internistů s nefrology v péči o nemocné s chronickým onemocněním ledvin. Vnitř Lek. 2022;68(7):426-431.
Go to original source...
Go to PubMed...
- van der Meer P, et al. Mitochondrial Function, Skeletal Muscle Metabolism, and Iron Deficiency in Heart Failure. Circulation. 2019;139(21):2399-2402.
Go to original source...
- Anker SD, et al. FAIRHF Trial: Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361(25):2436-2448.
Go to original source...
- Ponikowski P, et al. CONFIRMHF Trial: Beneficial effects of longterm intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2015;36(11):657-668.
Go to original source...
Go to PubMed...
- Ponikowski P, et al. AFFIRMAHF Trial: Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, doubleblind, randomised, controlled trial. Lancet. 2020;396(10266):1895-1904.
Go to original source...
- Melenovský V, Táborský M, Linhart A, et al. Expertní konsenzus k významu deficitu železa a možnosti jeho korekce u pacientů se srdečním selháním. Vnitř Lék. 2021;67(8):495-497.
Go to original source...
Go to PubMed...
- Lazárová M, Hlavinka A, Šulc P, et al. Využití telemedicíny u pacientů se srdečním selháním. Vnitř Lék. 2022;68(3):154-158.
Go to original source...
Go to PubMed...
- Pavlů L, Vícha M, Jelínek J, et al. Dlouhodobá mechanická srdeční podpora v terapii chronického srdečního selhání - reálná praxe. Vnitř Lék. 2021;67(8):E3-E6.
Go to original source...