Skip to main content

Leitliniengerechte Therapie der chronischen Herzinsuffizienz

Guideline satisfying therapy for chronic heart failure

Der Internist volume 48, pages 929–937 (2007)Cite this article

Zusammenfassung

Bei einer chronischen Herzinsuffizienz kann eine Einschränkung der systolischen Pumpfunktion und/oder der diastolischen Ventrikelfüllung bestehen. Die Basistherapie der systolischen Herzinsuffizienz umfasst einen ACE-Hemmer, Betablocker, bei Flüssigkeitsretention zusätzlich Diuretika und bei schwerster Symptomatik einen niedrig dosierten Aldosteronantagonisten. Ein AT1-Antagonist ist bei Patienten, die ACE-Hemmer nicht vertragen, als Alternative indiziert. Verbleiben Patienten trotz optimaler Pharmakotherapie im Stadium NYHA III–IV, können bei Nachweis einer kardialen Dyssynchronie durch die Implantation eines biventrikulären Schrittmachers die Beschwerden und die Prognose verbessert werden. Eine leitliniengerechte Behandlung reduziert bei systolischer Herzinsuffizienz deutlich die Mortalität und Morbidität. Zur Behandlung der diastolischen Herzinsuffizienz liegen bisher hingegen kaum Studienergebnisse vor. Die Therapie dieser Patienten bleibt meist noch empirisch.

Abstract

Chronic heart failure may be caused by systolic pump failure and/or impairment of diastolic filling of the ventricles. The standard pharmacotherapy for systolic heart failure includes an ACE inhibitor, betablocker, diuretics and, in patients with severe symptoms, a low dose aldosterone antagonist. An AT1 receptor blocker is indicated for those patients who do not tolerate ACE inhibitors. If patients remain in the functional class NYHA III-IV despite optimal medication and have cardiac dyssynchrony, biventricular pacing may improve the symptoms and prognosis. While evidence-based treatment significantly reduces morbidity and mortality in systolic heart failure, hardly any results from clinical trials are available for diastolic heart failure. Therefore, therapy in patients with diastolic heart failure remains in most cases empirical.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Abb. 1

Literatur

  1. Bardy GH, Lee KL, Mark DB et al. (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352: 225–237

    PubMed  Article  CAS  Google Scholar 

  2. Bart BA, Boyle A, Bank AJ et al. (2005) Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial. J Am Coll Cardiol 46: 2043–2046

    PubMed  Article  Google Scholar 

  3. Bhatia RS, Tu JV, Lee DS et al. (2006) Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 355: 260–269

    PubMed  Article  CAS  Google Scholar 

  4. Bristow MR, Saxon LA, Boehmer J et al. (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350: 2140–2150

    PubMed  Article  CAS  Google Scholar 

  5. CIBIS-II Investigators and Committees (1999) The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 353: 9–13

    Article  Google Scholar 

  6. Cleland JG, Daubert JC, Erdmann E et al. (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352: 1539–1549

    PubMed  Article  CAS  Google Scholar 

  7. Cleland JG, Findlay I, Jafri S et al. (2004) The Warfarin/Aspirin Study in Heart failure (WASH): a randomized trial comparing antithrombotic strategies for patients with heart failure. Am Heart J 148: 157–164

    PubMed  Article  CAS  Google Scholar 

  8. Cleland JG, Tendera M, Adamus J et al. (2006) The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 27: 2338–2345

    PubMed  Article  CAS  Google Scholar 

  9. Cohn JN, Tognoni G; for the Valsartan Heart Failure Trial Investigators (2001) A randomized trial of the angiotensin-receptor blocker Valsartan in chronic heart failure. N Engl J Med 345: 1667–1675

    PubMed  Article  CAS  Google Scholar 

  10. Costanzo MR, Guglin ME, Saltzberg MT et al. (2007) Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 49: 675–683

    PubMed  Article  CAS  Google Scholar 

  11. Flather MD, Shibata MC, Coats AJ et al. (2005) Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 26: 215–225

    PubMed  Article  CAS  Google Scholar 

  12. Granger CB, McMurray JJ, Yusuf S et al. (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet 362: 772–776

    PubMed  Article  CAS  Google Scholar 

  13. Hjalmarson A, Goldstein S, Fagerberg B et al. (2000) Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA 283: 1295–1302

    PubMed  Article  CAS  Google Scholar 

  14. Hoppe UC, Böhm M, Dietz R et al. (2005) Leitlinien zur Therapie der chronischen Herzinsuffizienz. Im Auftrag der Deutschen Gesellschaft für Kardiologie. Z Kardiol 94: 488–509

    PubMed  Article  CAS  Google Scholar 

  15. Hunt SA, Abraham WT, Chin MH et al. (2005) ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 112: e154–e235

    PubMed  Article  Google Scholar 

  16. Krum H, Roecker EB, Mohacsi P et al. (2003) Effects of initiating carvedilol in patients with severe chronic heart failure: results from the COPERNICUS Study. JAMA 289: 712–718

    PubMed  Article  CAS  Google Scholar 

  17. McMurray J, Cohen-Solal A, Dietz R et al. (2001) Practical recommendations for the use of ACE inhibitors, beta-blockers and spironolactone in heart failure: putting guidelines into practice. Eur J Heart Fail 3: 495–502

    PubMed  Article  CAS  Google Scholar 

  18. McMurray JJ, Ostergren J, Swedberg K et al. (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 362: 767–771

    PubMed  Article  CAS  Google Scholar 

  19. Moss AJ, Zareba W, Hall WJ et al. (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346: 877–883

    PubMed  Article  Google Scholar 

  20. Pitt B, Remme W, Zannad F et al. (2003) Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 348: 1309–1321

    PubMed  Article  CAS  Google Scholar 

  21. Pitt B, Zannad F, Remme WJ et al. (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 341: 709–717

    PubMed  Article  CAS  Google Scholar 

  22. Rathore SS, Curtis JP, Wang Y et al. (2003) Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 289: 871–878

    PubMed  Article  CAS  Google Scholar 

  23. Remme WJ, Swedberg K (2002) Comprehensive guidelines for the diagnosis and treatment of chronic heart failure. Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur J Heart Fail 4: 11–22

    PubMed  Article  Google Scholar 

  24. SOLVD Investigators (1991) Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 325: 293–302

    Article  Google Scholar 

  25. Swedberg K, Cleland J, Dargie H et al. (2005) Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 26: 1115–1140

    PubMed  Article  CAS  Google Scholar 

  26. Willenheimer R, Veldhuisen DJ van, Silke B et al. (2005) Effect on survival and hospitalization of initiating treatment for chronic heart failure with bisoprolol followed by enalapril, as compared with the opposite sequence: results of the randomized Cardiac Insufficiency Bisoprolol Study (CIBIS) III. Circulation 112: 2426–2435

    PubMed  Article  CAS  Google Scholar 

  27. Yusuf S, Pfeffer MA, Swedberg K et al. (2003) Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 362: 777–781

    PubMed  Article  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Affiliations

  1. Klinik III für Innere Medizin, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    U.C. Hoppe

Authors
  1. U.C. Hoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U.C. Hoppe.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hoppe, U. Leitliniengerechte Therapie der chronischen Herzinsuffizienz. Internist 48, 929–937 (2007). https://doi.org/10.1007/s00108-007-1898-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-007-1898-6

Schlüsselwörter

  • Herzinsuffizienz
  • Leitlinien
  • Pharmakotherapie
  • Evidenz
  • Kardiale Resynchronisation

Keywords

  • Heart failure
  • Guidelines
  • Pharmacotherapy
  • Evidence
  • Cardiac resynchronization