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Blick in die Glaskugel

Herzinsuffizienz

  • Schwerpunkt_Kardiologie
  • Published:
CardioVasc Aims and scope

Zusammenfassung

Die Prognose der Herzinsuffizienz hat sich in den letzten drei Jahrzehnten erheblich verbessert. Insbesondere neue Behandlungsoptionen von kardiovaskulären Erkrankungen, wie arteriellem Hypertonus, koronarer Herzerkrankung, Klappenerkrankungen und die eigentliche Herzinsuffizienztherapie, inklusive ACE-Inhibitoren, Betablockern und Mineralkortikoid-Antagonisten, haben dies bewirkt [1, 2]. Trotz dieser Fortschritte steigt die Prävalenz der Herzinsuffizienz stetig (bei über 70-jährigen Patienten ≥ 10 %) und Morbidität und Mortalität sind weiterhin hoch [1], sodass neuen und ergänzenden therapeutischen Strategien eine immer größere Bedeutung zukommt. In dem folgenden Übersichtsartikel zur Herzinsuffizienz besprechen wir neue Therapieansätze der chronischen Herzinsuffizienz, der diastolischen Herzinsuffizienz (Herzinsuffizienz bei erhaltener linksventrikulärer Pumpfunktion) und der akuten Herzinsuffizienz und gehen auf vielversprechende zukünftige therapeutische Strategien ein. Ein weiterer Fokus ist eine optimierte Patientenbetreuung durch eine nahtlose stationäre und ambulante Versorgungsstruktur mit dem Ziel der Reduktion der erneuten Krankenhausaufenthalte.

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Literatur

  1. McMurray et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787–847

    Article  PubMed  Google Scholar 

  2. Mosterd A et al. Clinical epidemiology of heart failure. Heart. 2007;93:1137–46

    Article  PubMed Central  PubMed  Google Scholar 

  3. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316:1429-35

  4. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293-302

  5. Packer M, Coats AJ, Fowler MB et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001;344:1651–8

    Article  CAS  PubMed  Google Scholar 

  6. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999;353:2001-7

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

  8. Pitt et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341: 709–17

    Article  CAS  PubMed  Google Scholar 

  9. Zannad et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364:11–21

    Article  CAS  PubMed  Google Scholar 

  10. Askoxylakis V et al. Long-term survival of cancer patients compared to heart failure and stroke: a systematic review. BMC Cancer. 2010;10:105

    Article  PubMed Central  PubMed  Google Scholar 

  11. McMurray et al. Angiotensin-Neprilysin Inhibition versus Enalapril in Heart Failure. N Engl J Med. 2014;371:993–1004

    Article  CAS  PubMed  Google Scholar 

  12. Hoekstra et al. Quality of life and survival in patients with heart failure. Eur J Heart Fail. 2013;15:94–102

    Article  PubMed  Google Scholar 

  13. Anker et al. Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency. N Engl J Med. 2014, 361;25: 2436–48

    Article  Google Scholar 

  14. Owan et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251–9

    Article  CAS  PubMed  Google Scholar 

  15. Pitt et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309–21. [Erratum, N Engl J Med. 2003;348:2271.]

    Article  CAS  PubMed  Google Scholar 

  16. Pitt B, Pfeffer MA, Assmann SF et al. Spironolactone for Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2014;370(15):1383–92

    Article  CAS  PubMed  Google Scholar 

  17. Gheorghiade et al. Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol. 2005;96:11–7

    Article  Google Scholar 

  18. Gheorghiade et al. Acute heart failure syndromes. J Am Coll Cardiol. 2009;53:557–73

    Article  PubMed  Google Scholar 

  19. Maggioni et al. EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2010;12:1076–84

    Article  PubMed  Google Scholar 

  20. Loehr et al. Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study). Am J Cardiol. 2008;101:1016–22

    Article  PubMed  Google Scholar 

  21. Maggioni et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013;15:808–17

    Article  PubMed  Google Scholar 

  22. Cuffe et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. 2002;287:1541–7

    Article  CAS  PubMed  Google Scholar 

  23. McMurray et al. Effects of tezosentan on symptoms and clinical outcomes in patients with acute heart failure: the VERITAS randomized controlled trials. JAMA. 2007;298:2009–19

    Article  CAS  PubMed  Google Scholar 

  24. Mebazaa et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA. 2007;297:1883–91

    Article  CAS  PubMed  Google Scholar 

  25. Konstam et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA. 2007;297:1319–31

    Article  CAS  PubMed  Google Scholar 

  26. Massie et al. Rolofylline, an adenosine A1-receptor antagonist, in acute heart failure. N Engl J Med. 2010;363:1419–28

    Article  PubMed  Google Scholar 

  27. O’Connor et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365:32–4

    Article  PubMed  Google Scholar 

  28. Felker et al. Clinical trials of pharmacological therapies in acute heart failure syndromes: lessons learned and directions forward. Circ Heart Fail. 2010;3:314–25

    Article  PubMed  Google Scholar 

  29. Cotter et al. Physician-determined worsening heart failure: a novel definition for early worsening heart failure in patients hospitalized for acute heart failure—association with signs and symptoms, hospitalization duration, and 60-day outcomes. Cardiology. 2010;115:29–36

    Article  PubMed  Google Scholar 

  30. Weatherley et al. Early worsening heart failure in patients admitted with acute heart failure—a new outcome measure associated with long-term prognosis? Fund Clin Pharmacol. 2009;23:633–9

    Article  CAS  Google Scholar 

  31. Conrad et al. Effects of relaxin on arterial dilation, remodeling, and mechanical properties. Curr Hypertens Rep. 2011;13(6):409–20

    Article  CAS  PubMed  Google Scholar 

  32. Jelinic et al. Localization of relaxin receptors in arteries and veins, and region-specific increases in compliance and bradykinin-mediated relaxation after in vivo serelaxin treatment. FASEB J. 2014;28(1):275–87

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Ghofrani et al. Riociguat for the Treatment of Chronic Thromboembolic Pulmonary Hypertension. N Engl J Med. 2013;369(4):319–29

    Article  CAS  PubMed  Google Scholar 

  34. Ghofrani et al. Riociguat for the Treatment of Pulmonary Arterial Hypertension. N Engl J Med. 2013;369(4):330–40

    Article  CAS  PubMed  Google Scholar 

  35. Maron et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113:1807–16

    Article  PubMed  Google Scholar 

  36. Metra et al. Early worsening heart failure in patients admitted with acute heart failure—a new outcome measure associated with long-term prognosis? Eur Heart J. 2011;32:1519–34

    Article  CAS  PubMed  Google Scholar 

  37. Felix et al. [Immunoadsorption for treatment of dilated cardiomyopathy]. Internist. 2008;49(1):51–6

    Article  CAS  PubMed  Google Scholar 

  38. Dörffel et al. Short-term hemodynamic effects of immunoadsorption in dilated cardiomyopathy. CirculationCirculation. 1997;95:1994–7

    Article  PubMed  Google Scholar 

  39. Solomon SD, Dobson J, Pocock S et al. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation, 2007;116(13):1482–7

    Article  PubMed  Google Scholar 

  40. Gensichen J, Beyer M, Kuver C et al. Case Management für Patienten mit Herzinsuffizienz in der ambulanten Versorgung - Ein kritischer Review. Z Arztl Fortbild Qualitatssich. 2004;98(2):143–54

    PubMed  Google Scholar 

  41. Gonseth J, Guallar-Castillon P, Banegas JR et al. The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J. 2004;25(18):1570–95

    Article  PubMed  Google Scholar 

  42. Gustafsson F, Arnold JM. Heart failure clinics and outpatient management: review of the evidence and call for quality assurance. Eur Heart J. 2004;25(18):1596–604

    Article  PubMed  Google Scholar 

  43. Holland R, Battersby J, Harvey I et al. Systematic review of multidisciplinary interventions in heart failure. Heart 2005;91(7):899–90

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. McAlister FA, Stewart S, Ferrua S et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol 2004;44(4):810–9

    PubMed  Google Scholar 

  45. Phillips CO, Wright SM, Kern DE et al. Comprehensive discharge planning with postdischarge support for older patients with congestive heartfailure: a meta-analysis. JAMA. 2004;291(11):1358–67

    Article  CAS  PubMed  Google Scholar 

  46. Wagner EH. Deconstructing heart failure disease management. Ann Intern Med. 2004;141(8):644–6

    Article  PubMed  Google Scholar 

  47. Edelmann F, Wachter R, Schmidt AG et a.Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: the Aldo-DHF randomized controlled trial. JAMA. 2013;309(8):781–91

    Article  CAS  PubMed  Google Scholar 

  48. Angermann CE, Störk S, Gelbrich G et al. Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study. Circ Heart Fail. 2012;5(1):25–35

    Article  PubMed  Google Scholar 

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Correspondence to Carolin Sonne.

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Interessenkonflikt

Die Autoren erklären, dass sie sich bei der Erstellung des Beitrages von keinen wirtschaftlichen Interessen leiten ließen und dass keine potenziellen Interessenkonflikte vorliegen. Der Verlag erklärt, dass die inhaltliche Qualität des Beitrags von zwei unabhängigen Gutachtern geprüft wurde. Werbung in dieser Zeitschriftenausgabe hat keinen Bezug zur CME-Fortbildung. Der Verlag garantiert, dass die CME-Fortbildung sowie die CME-Fragen frei sind von werblichen Aussagen und keinerlei Produktempfehlungen enthalten. Dies gilt insbesondere für Präparate, die zur Therapie des dargestellten Krankheitsbildes geeignet sind.

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Sonne, C., Frantz, S. Herzinsuffizienz. CV 15, 30–34 (2015). https://doi.org/10.1007/s15027-015-0598-8

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  • DOI: https://doi.org/10.1007/s15027-015-0598-8

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