New perspectives in the treatment of chronic heart failure

Česká verzia

Authors: Barbora Nussbaumerová
Authors place of work: Centrum preventivní kardiologie, II. interní klinika LF a FN v Plzni, UK v Praze
Published in the journal: Vnitř Lék 2023; 69(2): 82-87
Category: Main Topic
doi: https://doi.org/10.36290/vnl.2023.015

Summary

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 – SGLT2 inhibitors – heart failure – guidelines

Zdroje

1. 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.

2. Špinar J, Špinarová L, Vítovec J. Co internistům přinášejí nová doporučení ESC pro léčbu srdečního selhání 2021? Vnitř Lék. 2022;68(2):104-110.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. Prázný M. SGLT-2 inhibitory a jejich uplatnění v praxi – update 2022. Vnitř Lék. 2022;68(2):96-103.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. van der Meer P, et al. Mitochondrial Function, Skeletal Muscle Metabolism, and Iron Deficiency in Heart Failure. Circulation. 2019;139(21):2399-2402.

20. 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.

21. 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.

22. 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.

23. 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.

24. Lazárová M, Hlavinka A, Šulc P, et al. Využití telemedicíny u pacientů se srdečním selháním. Vnitř Lék. 2022;68(3):154-158.

25. 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.