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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Current Approaches to Worsening Heart Failure: Pathophysiological and Molecular Insights

International Journal of Molecular Sciences, Journal Year: 2024, Volume and Issue: 25(3), P. 1574 - 1574

Published: Jan. 26, 2024

Worsening heart failure (WHF) is a severe and dynamic condition characterized by significant clinical hemodynamic deterioration. It worsening HF signs, symptoms biomarkers, despite the achievement of an optimized medical therapy. remains challenge in cardiology, as it evolves into advanced end-stage HF. The hyperactivation neurohormonal, adrenergic renin-angiotensin-aldosterone system are well known pathophysiological pathways involved Several drugs have been developed to inhibit latter, resulting improvement life expectancy. Nevertheless, patients exposed residual risk adverse events, exploration new molecular therapeutic targets required. This review explores current landscape WHF, highlighting complexities factors contributing this critical condition. Most recent advances introduced cutting-edge pharmacological agents, such guanylate cyclase stimulators myosin activators. Regarding device-based therapies, invasive pulmonary pressure measurement cardiac contractility modulation emerged promising tools increase quality reduce hospitalizations due exacerbations. Recent innovations terms WHF management emphasize need for multifaceted patient-centric approach address complex syndrome.

Language: Английский

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Dietary sodium and fluid intake in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC

European Journal of Heart Failure, Journal Year: 2024, Volume and Issue: 26(4), P. 730 - 741

Published: April 1, 2024

Language: Английский

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How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC

European Journal of Heart Failure, Journal Year: 2024, Volume and Issue: 26(6), P. 1278 - 1297

Published: May 22, 2024

Abstract Guideline‐directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF) reduces morbidity mortality, but its implementation is often poor daily clinical practice. Barriers to include organizational factors that might contribute inertia, i.e. avoidance/delay of recommended treatment initiation/optimization. The spectrum strategies be applied foster GDMT wide, involves the set‐up care pathways, tailored drug initiation/optimization increasing chance successful implementation, digital tools/telehealth interventions, educational activities targeting patient/physician awareness, use quality registries. This scientific statement by Heart Failure Association ESC provides an overview current state HFrEF, barriers aims at suggesting a comprehensive framework on how overcome inertia ultimately improve HFrEF based up‐to‐date evidence.

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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Epidemiology, pathophysiology, diagnosis and management of chronic right‐sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC

European Journal of Heart Failure, Journal Year: 2023, Volume and Issue: 26(1), P. 18 - 33

Published: Dec. 22, 2023

Right‐sided heart failure and tricuspid regurgitation are common strongly associated with poor quality of life an increased risk hospitalizations death. While medical therapy for right‐sided is limited, treatment options include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from valve interventions yet unknown, as ideal time these treatments given paucity clinical evidence. In this context, it crucial to elucidate aetiology pathophysiological mechanisms leading in order recognize when a mere bystander can cause or contribute progression. Notably, early identification right may be optimal management requires knowledge about different causes, course presentation, well possible options. The aim consensus statement summarize current epidemiology, pathophysiology providing practical suggestions patient management.

Language: Английский

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Remote Dielectric Sensing Before and After Discharge in Patients With ADHF

JACC Heart Failure, Journal Year: 2024, Volume and Issue: 12(4), P. 695 - 706

Published: Feb. 28, 2024

Language: Английский

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Implementation of guideline‐recommended therapies in heart failure with reduced ejection fraction according to heart failure duration: An analysis of 55 581 patients from the Swedish Heart Failure (SwedeHF) Registry

European Journal of Heart Failure, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 9, 2025

Abstract Aims Guidelines recommend immediate initiation of all four class I guideline‐directed medical therapies, renin–angiotensin system inhibitors (RASI) or angiotensin receptor–neprilysin (ARNI), beta‐blockers, mineralocorticoid receptor antagonists (MRA) and sodium–glucose cotransporter 2 (SGLT2i) following the diagnosis heart failure (HF) with reduced ejection fraction (HFrEF). The extent to which this occurs in new‐onset HFrEF is unclear. We assessed guideline‐recommended therapies during first year a diagnosis. Methods results Swedish HF Registry was linked additional national registries. In patients (ejection <40%), clinical characteristics treatment from when they were available recommended guidelines according time (<3, 3 <6, 6–12 >12 months). Of 55 581 enrolled between 2000 2021, 54%, 5.8%, 4.8% 36% had an duration <3, months, respectively. Patients shorter younger, lower New York Heart Association fewer cardiovascular comorbidities. Within <6 months diagnosis, 93%, 92%, 90% 89% on RASI ARNI, 9.8%, 17%, 19% 22% ARNI alone, 35%, 43%, 44% 46% MRA, 92% 91% 26%, 30%, 28% SGLT2i, Additionally, 18% received cardiac resynchronization therapy/implantable cardioverter‐defibrillator after Conclusions Most beta‐blockers Use MRA SGLT2i limited, both early later periods. Our findings suggest that strategies improve use remain urgently needed.

Language: Английский

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Worsening Heart Failure and Medication Use in HFrEF: A Finnish Retrospective Registry Study and Patient Survey

International Journal of Heart Failure, Journal Year: 2025, Volume and Issue: 7(1), P. 6 - 6

Published: Jan. 1, 2025

Understanding worsening heart failure events (WHFEs) and clinical practices in the real world is essential (HF) management. The primary objective of this single-center, retrospective, observational study, including a patient survey, was to characterize WHFEs associated factors during first year after incident HF diagnosis Finnish patients. Secondly, implementation adherence guideline-directed medical therapy (GDMT) mortality whole follow-up were assessed. Incident patients (International Classification Diseases, 10th Revision: I50) with reduced ejection fraction (HFrEF; <40%) identified between 2013-2019 from hospital data lake Southwest Finland. Clinical characteristics, healthcare resource utilization, medication prescriptions purchases, deaths collected records national registers 2011-2021. A survey linked register for subgroup Associations explanatory factors, WHFEs, studied using logistic Cox regression models. Among 570 HFrEF patients, 23% (n=133) experienced WHFE within diagnosis. During 1-year period, 85% used angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 90% beta-blockers, 44% mineralocorticoid antagonists, >80% adherent these medications. higher risk (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.31-2.53; p<0.001), whereas lower (odds ratio, 0.31; CI, 0.20-0.48; p<0.001) (HR, 0.66; 0.47-0.94; p=0.021) multivariate Quality life (n=47) than without (n=100). Improving crucial mitigating adverse outcomes HF.

Language: Английский

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The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart Failure

Biomedicines, Journal Year: 2025, Volume and Issue: 13(3), P. 608 - 608

Published: March 3, 2025

Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as antihyperglycemic agents, have revolutionized heart failure (HF) management, offering substantial benefits across all stages and phenotypes of the disease. Regardless left ventricular ejection fraction (LVEF), these agents proven efficacy in both chronic acute HF presentations. This review explores SGLT2i applications spanning continuum, from early (Stage A) at-risk individuals to mitigation progression advanced D). Evidence numerous trials has shown that significantly lower rates hospitalization, improve renal function, decreases cardiovascular mortality, highlighting their multifaced mechanisms action care. also highlights potential by which exert beneficial effects on systems, each contributing sustained clinical improvements. However, integration into guideline-directed medical therapy poses practical challenges, including initiation timing, dosing, monitoring, are addressed support effective treatment adaptation patient populations. Ultimately, this provides a comprehensive assessment foundational HF, emphasizing role an intervention multiple aimed at improving outcomes entire spectrum.

Language: Английский

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