Recent researchers have british medical journal This paper reviewed diagnostic and management data for heart failure.

Heart failure poses a significant health and economic burden around the world, especially among older adults. Recent scientific discoveries have led to the development of new drugs and improved prognosis for patients with heart failure. These include new drugs, technologies, and diagnostic approaches. Although clinical standards have incorporated these improvements, their treatment and diagnostic suggestions are often outdated.

Clinical review: Advances in heart failure management. Image credit: santoelia / Shutterstock

About reviews

In this review, researchers present the latest aspects of heart failure management.

Researchers searched the Cochrane and PubMed databases for randomized clinical trials (RCTs), epidemiological studies, and cohort studies on the diagnosis and treatment of heart failure published between January 2015 and July 7, 2023. . These studies included those excluded from the 2021-2022 Heart Failure Society Meeting. United States/American College of Cardiology/American Heart Association (HFSA/ACC/AHA) and European Society of Cardiology (ESC) guidelines (excluding case reports and case series).

Epidemiology and diagnosis of heart failure

The Global Burden of Disease (GBD) study reported 57 million heart failure events in 2019, with age-standardized rates decreasing from 7.70 per 1,000 to 7.10 per 1,000 from 2010 to 2019. did. In the United States, young people are being hospitalized for heart failure at an increasing rate. Survival rates after diagnosis are low and highly dependent on age. Changes in heart failure treatment include increased use of basic drug classes, sodium-glucose cotransporter-2 (SGL-2) inhibitors, and life-sustaining drugs.

Heart failure is characterized by cardiac dysfunction, reduced left ventricular systolic function (≤40%), or increased filling pressure. This condition is classified according to left ventricular ejection fraction (LVEF) into heart failure with reduced ejection fraction (HFrEF), heart failure with minimally reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFrEF). HFpEF).

Diagnosis of HFpEF is difficult because elevated filling pressures are difficult to identify. Although invasive methods are the gold standard for identifying elevated left ventricular filling pressures, clinical scores such as HFA-PEFF and H2FPEF indicate non-invasive diagnosis. Determining the etiology of heart failure is very important because some diseases require special treatment. Cardiac magnetic resonance (CMR) scans are beneficial for people with dilated cardiomyopathy or blood vessels that are significantly enlarged on echocardiography.

Advances in heart failure management

Patients with HFrEF are treated with SGLT2 inhibitors, renin-angiotensin system (RAS) inhibitors, angiotensin receptor blockers (ARBs), angiotensin receptor/neprilysin inhibitory molecules (ARNIs), beta-blockers, mineralocorticoid receptor antagonists ( MRA) is prescribed. Combining these four pillars of his HFrEF drugs can reduce the relative risk of mortality by 73% compared to no treatment, and also reduce the number of treatments needed to avoid death (NNT).

Combination treatment of ARBs and ARNIs is a key component of heart failure management. The SGL-2 inhibitor family was developed to enhance glycemic control in diabetes and can improve cardiac outcomes, including prevention of heart failure. This class, which includes dapagliflozin and empagliflozin, is currently considered one of the four main preventive drugs for heart failure and diabetes. During follow-up, in approximately 15% of patients with heart failure, left ventricular function (LVEF) is observed to increase from less than 40% to more than 40%. SGLT2 inhibitors are the first line of treatment for individuals with moderately reduced or maintained LVEF. Other treatments for HFrEF include ARNIs, ACE inhibitors, ARBs, and MRAs, but these are considered second-line therapies as there is little evidence of efficacy.

The African American Heart Failure Trial proposes a combination of drugs for black people with NYHA class III or IV heart failure. Ivabradine, an inhibitor of cardiac pacemaker currents, reduced cardiovascular mortality and heart failure hospitalizations by 18% in people with sinus rhythm and heart rate of 70 bpm or higher. In the VICTORIA trial, vericiguat, a new heart failure drug that increases vasodilation and reduces cardiac remodeling, reduced the risk of cardiovascular mortality or hospitalization by 10%.

Heart failure resynchronization therapy (HFrEF) includes implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT). Healthcare professionals must consider individual patient preferences and potential benefits when making common decisions about ICD placement. Transcatheter edge-to-edge repair (TEER) is a viable treatment option for people with chronic severe mitral regurgitation.

Based on the review results, care for patients with heart failure has changed dramatically with the introduction of four life-prolonging drug classes for those with low LVEF and SGLT2 inhibitors for those with mildly reduced and maintained LVEF. However, accurate diagnosis remains difficult. Further research is needed to understand optimal initiation methods and causes of variation in heart failure prevalence. In addition, research should investigate the benefits of drugs for maintaining LVEF and whether patients should stop taking the drug once symptoms improve and left ventricular function returns to normal.