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Current drug therapy for heart failure with reduced ejection fraction

Medikamentöse Therapie der Herzinsuffizienz mit reduzierter systolischer LV-Funktion

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Abstract

The prevalence of heart failure has been steadily increasing during the past few years, with a further increase predicted in the years to come. Without treatment, the syndrome of heart failure has a very poor prognosis. Advances in drug treatments and the consequent implementation of a guideline-recommended drug therapy have significantly improved the prognosis in heart failure with reduced ejection fraction (HFrEF). Besides angiotensin-converting enzyme (ACE) inhibitors (ACEi) or angiotensin receptor blockers, beta-blockers and diuretics treatment with mineralocorticoid receptor antagonists and ivabradine have become standard in the therapy of symptomatic patients with HFrEF. Recently, the impact of the adequate dosage of ACEi and beta-blockers was emphasized again. Angiotensin receptor-neprilysin inhibition is an auspicious new therapeutic approach and is predicted to play a crucial role in heart failure treatment in the coming years. The role of cardiac glycosides in the modern era of heart failure therapy is the focus of a current randomized controlled trial. Last but not least, potassium binders such as the new substance patiromer might help in overcoming the problem of hyperkalemia, which frequently limits the dosing of vital heart failure drugs. These advances offer optimism for further improvements in the prognosis and quality of life of HFrEF patients.

Zusammenfassung

Die Prävalenz der Herzinsuffizienz ist in den vergangenen Jahren stetig gestiegen, in den nächsten Jahren wird ein weiterer Anstieg erwartet. Unbehandelt ist das Syndrom Herzinsuffizienz mit einer sehr schlechten Prognose vergesellschaftet. Fortschritte in der medikamentösen Therapie und die konsequente Umsetzung von Leitlinienempfehlungen haben dazu geführt, dass die Prognose der Patienten mit Herzinsuffizienz mit reduzierter Pumpfunktion (HFrEF) deutlich verbessert wurde. Neben ACE-Hemmern oder Angiotensinrezeptorblockern, Betablockern und Diuretika ist die Behandlung mit einem Mineralokortikoidrezeptorantagonisten und Ivabradin Standard bei symptomatischen Patienten mit HFrEF. Die Bedeutung einer adäquaten Dosierung der ACE-Hemmer und Betablocker ist erst kürzlich wieder gezeigt worden. Die Angiotensinrezeptor-Neprilysin-Inhibition ist ein vielversprechender neuer therapeutischer Ansatz, der voraussichtlich in den kommenden Jahren eine tragende Rolle in der Therapie der Herzinsuffizienz erhalten wird. Die Bedeutung kardialer Glykoside bei der modernen Herzinsuffizienztherapie wird aktuell in einer randomisierten und kontrollierten Studie untersucht. Nicht zuletzt könnten Kaliumbinder wie die neue Substanz Patiromer helfen, das Problem der Hyperkaliämie zu beheben, das häufig zu einer Limitierung in der Dosierung wichtiger Herzinsuffizienzmedikamente führt. Insgesamt lassen diese Fortschritte auf eine weitere Verbesserung von Prognose und Lebensqualität bei Patienten mit HFrEF in der nahen Zukunft hoffen.

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Authors and Affiliations

  1. Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    D. Berliner MD, M. Hallbaum & J. Bauersachs

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Correspondence to D. Berliner MD.

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Conflict of interest

D. Berliner received honoraria and/or travel support from the following companies and/or is a member of their advisory boards: Novartis, Abbott, Daiichi Sankyo, Bayer and Boehringer Ingelheim. M. Hallbaum received honoraria for advice and travel support from St. Jude Medical/Abbott, Vifor, CVRx and Bristol Meyer Squibb. J. Bauersachs received honoraria for lectures and advice from Novartis, Pfizer, Vifor, Bayer, Servier, Orion, CVRx, Abbott/SJM/Thoratec and Medtronic/Heartware, and research support from Zoll, CVRx, Bayer, Vifor, Abiomed and Medtronic.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Berliner, D., Hallbaum, M. & Bauersachs, J. Current drug therapy for heart failure with reduced ejection fraction. Herz 43, 383–391 (2018). https://doi.org/10.1007/s00059-018-4712-4

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