2024 update in heart failure

ESC Heart Failure, Journal Year: 2024, Volume and Issue: unknown

Published: May 28, 2024

Abstract In the last years, major progress has occurred in heart failure (HF) management. The 2023 ESC focused update of 2021 HF guidelines introduced new key recommendations based on results years science. First, two drugs, sodium–glucose co‐transporter‐2 (SGLT2) inhibitors and finerenone, a novel nonsteroidal, selective mineralocorticoid receptor antagonist (MRA), are recommended for prevention patients with diabetic chronic kidney disease (CKD). Second, SGLT2 now treatment across entire left ventricular ejection fraction spectrum. benefits quadruple therapy reduced (HFrEF) well established. Its rapid early up‐titration along close follow‐up frequent clinical laboratory re‐assessment after an episode acute (the so‐called ‘high‐intensity care’ strategy) was associated better outcomes STRONG‐HF trial. Patients experiencing worsening might require fifth drug, vericiguat. STEP‐HFpEF‐DM STEP‐HFpEF trials, semaglutide 2.4 mg once weekly administered 1 year decreased body weight significantly improved quality life 6 min walk distance obese preserved (HFpEF) or without history diabetes. Further data safety efficacy, including also hard endpoints, needed to support addition acetazolamide hydrochlorothiazide standard diuretic regimen hospitalized due HF. meantime, PUSH‐AHF supported use natriuresis‐guided therapy. options most recent evidence HF, specific drugs cardiomyopathies (i.e., mavacamten hypertrophic cardiomyopathy tafamidis transthyretin cardiac amyloidosis), device therapies, contractility modulation percutaneous valvulopathies, finding from TRILUMINATE Pivotal trial, reviewed this article.

Language: Английский

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International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates—2024

The Journal of Heart and Lung Transplantation, Journal Year: 2024, Volume and Issue: 43(10), P. 1529 - 1628.e54

Published: Aug. 8, 2024

Language: Английский

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Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care

ESC Heart Failure, Journal Year: 2022, Volume and Issue: 9(3), P. 1507 - 1523

Published: March 30, 2022

Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality life burden for the healthcare system. The number patients that progress to an advanced stage HF growing. Only limited proportion these can undergo heart transplantation or mechanical circulatory support. purpose this review summarize medical management with HF. First, evidence-based oral treatment must be implemented although it often not tolerated. New therapeutic options may soon become possible patients. second goal lessen symptomatic through both decongestion haemodynamic improvement. Some new treatments acting on cardiac function fulfil needs. Inotropic agents increase in intracellular calcium have increased risk death. However, recent Global Approach Lowering Adverse Cardiac Outcomes Through Improving Contractility Failure (GALACTIC-HF) trial, omecamtiv mecarbil was safe effective reduction primary outcome cardiovascular death event compared placebo (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99; P = 0.03) its effects were larger those more severe left ventricular dysfunction. Patients who received experienced significant benefit, whereas without did (P 0.005 interaction). Lastly, clinicians should take care end appropriate multidisciplinary approach. Medical therefore remains challenge wide open area further research.

Language: Английский

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Heart failure: an update from the last years and a look at the near future

ESC Heart Failure, Journal Year: 2022, Volume and Issue: 9(6), P. 3667 - 3693

Published: Dec. 1, 2022

Abstract In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all patients with HF reduced ejection fraction. Whilst verciguat becoming available across several countries, omecamtiv mecarbil waiting to be released clinical use. Concurrent use of potassium‐lowering agents may counteract hyperkalaemia and facilitate renin–angiotensin–aldosterone system inhibitor implementations. The results EMPagliflozin outcomE tRial Patients With chrOnic heaRt Failure Preserved Ejection Fraction (EMPEROR‐Preserved) trial were confirmed by Dapagliflozin Heart Mildly Reduced or (DELIVER) trial, we have, first time, evidence treatment also preserved a pre‐specified meta‐analysis randomized controlled trials, sodium–glucose co‐transporter‐2 inhibitors all‐cause mortality, cardiovascular (CV) hospitalization regardless left ventricular Other steps forward have decompensated HF. Acetazolamide Acute Decompensated Volume Overload (ADVOR) showed that addition intravenous acetazolamide loop diuretics leads greater decongestion vs. placebo. hydrochlorothiazide was evaluated CLOROTIC trial. Torasemide did not change outcomes, compared furosemide, TRANSFORM‐HF. Ferric derisomaltose had an effect on primary outcome CV mortality rehospitalizations IRONMAN (rate ratio 0.82; 95% confidence interval 0.66–1.02; P = 0.070). Further options HF, including device therapies, cardiac contractility modulation, percutaneous valvulopathies, are summarized this article.

Language: Английский

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Guideline‐directed medical therapy in severe heart failure with reduced ejection fraction: An analysis from the HELP‐HF registry

European Journal of Heart Failure, Journal Year: 2023, Volume and Issue: 26(2), P. 327 - 337

Published: Nov. 7, 2023

Persistent symptoms despite guideline-directed medical therapy (GDMT) and poor tolerance of GDMT are hallmarks patients with advanced heart failure (HF) reduced ejection fraction (HFrEF). However, real-world data on use, dose, prognostic implications lacking.

Language: Английский

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Medical therapy of cardiogenic shock: Contemporary use of inotropes and vasopressors

European Journal of Heart Failure, Journal Year: 2024, Volume and Issue: 26(2), P. 411 - 431

Published: Feb. 1, 2024

Language: Английский

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Impact of malnutrition in patients with severe heart failure

European Journal of Heart Failure, Journal Year: 2024, Volume and Issue: 26(7), P. 1585 - 1593

Published: May 29, 2024

Language: Английский

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Prognostic impact of the updated 2018 HFA‐ESC definition of advanced heart failure: results from the HELP‐HF registry

European Journal of Heart Failure, Journal Year: 2022, Volume and Issue: 24(9), P. 1493 - 1503

Published: May 23, 2022

The Heart Failure Association of the European Society Cardiology (HFA-ESC) proposed a definition advanced heart failure (HF) that has not been validated, yet. We assessed its prognostic impact in consecutive series patients with high-risk HF.The HELP-HF registry enrolled HF and at least one 'I NEED HELP' marker, evaluated four Italian centres between 1st January 2020 30th November 2021. Patients meeting HFA-ESC were compared to this definition. primary endpoint was composite all-cause mortality or first hospitalization. Out 4753 screened, 1149 (24.3%) marker included (mean age 75.1 ± 11.5 years, 67.3% male, median left ventricular ejection fraction [LVEF] 35% [interquartile range 25%-50%]). Among them, 193 (16.8%) met As others, these younger, had lower LVEF, higher natriuretic peptides worse clinical profile. 1-year rate 69.3% according versus 41.8% others (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.82-2.74, p < 0.001). confirmed after multivariable adjustment for relevant covariates (adjusted HR 1.98, CI 1.57-2.50, 0.001).The strong contemporary, real-world, multicentre cohort HF.

Language: Английский

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The Effectiveness of Eplerenone vs Spironolactone on Left Ventricular Systolic Function, Hospitalization and Cardiovascular Death in Patients With Chronic Heart Failure–HFrEF

Medical Archives, Journal Year: 2023, Volume and Issue: 77(2), P. 105 - 105

Published: Jan. 1, 2023

Heart failure remains one of the most prevalent clinical syndromes associated with significant morbidity and mortality. According to current guidelines, prescription a MRA is recommended reduce risk HF hospitalization death in all patients symptomatic heart no contraindications for this therapy.The aim our study was determine efficacy eplerenone vs. spironolactone on left ventricular systolic function by measuring ventricle ejection fraction (LVEF) chronic failure, especially their effect preventing hospitalization, reducing mortality, improving status among HF.From June 2021 2022, randomized, prospective trial single blind study. A total 142 reduced were selected random sampling. Each patient randomly allocated into either two groups continued receiving treatment (Spiron-HF group) or (Epler-HF group). Patients Epler-HF group compared an arm same size matched age gender Spiron-HF management HFrEF. evaluated clinically, biochemically, echocardiographically at beginning (baseline) after 6 months end 12th month. Echocardiography performed find out change function.After 12 treatment, improvement observed treated (37.9 ± 3.8 4.6 versus 40.1 5.7 group; P < 0.05). reduction end-systolic volume (6.3 2.5ml 17.8± 4.4ml 0.05) diameter (2.7 0.5ml 6.7 0.2ml 0.05), occurred treatment. Left global longitudinal strain (LV GLS) significantly improved (0.6 0.4 3.4 0.9; There differences end-diastolic (2.2 0.5 ml 4.7 1.1ml; =0.103) diastolic (1.2 0.6 1.7 0.3; P=0.082) both arms. The effects agents primary composite outcome, each individual mortality hospital admission outcomes are shown Figure 1 2. showed statistically lower cardiovascular (HR 0.53; 95% CI 0.34-0.82; p= 0.007) all-cause 0.64; 0.44-0.93; 0.022) than group. statistical analysis did not show difference between Epler -HF regarding outcome; due (Hazard Ratio (HR) = 0.95; Confidence Interval (CI) 0.73- 1.27; 0.675).Our has demonstrated favorable cardiac remodeling parameters ability effectively block mineralocorticoid receptor while minimizing side confirms its key role

Language: Английский

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Detailed Assessment of the “I Need Help” Criteria in Patients With Heart Failure: Insights From the HELP-HF Registry

Circulation Heart Failure, Journal Year: 2023, Volume and Issue: 16(12)

Published: Nov. 1, 2023

The "I Need Help" markers have been proposed to identify patients with advanced heart failure (HF). We evaluated the prognostic impact of these on clinical outcomes in a real-world, contemporary, multicenter HF population.

Language: Английский

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