Download PDF
Dtsch Med Wochenschr 2020; 145(19): 1384-1390
DOI: 10.1055/a-1040-1078
Dossier

Medikamentöse Therapie der Herzinsuffizienz mit reduzierter Pumpfunktion

Pharmacotherapy in HFrEF
Gülmisal Güder
,
Stefan Frantz
› Further Information
Also available at
    Permissions and Reprints

Seit Veröffentlichung der Leitlinien im Jahr 2016 lieferte eine Vielzahl von klinischen Studien neue Evidenz zur Therapieoptimierung der Herzinsuffizienz mit reduzierter Pumpfunktion (HFrEF). Gleichzeitig gestaltet sich aufgrund der Behandlungsvielfalt sowie häufiger Begleiterkrankungen die ohnehin komplexe HFrEF-Therapie schwieriger denn je. Dieser Artikel bietet ein Update zur aktuellen medikamentösen Therapie bei der HFrEF.

Abstract

Since publication of the European Society guidelines for the diagnosis and treatment of acute and chronic heart failure in 2016, numerous studies provided new evidence how to further optimize heart failure therapy.

Besides recent device-based therapeutic options, promising new drug developments give a glimmer of hope that the prognosis of this progressive heart disease could be somehow more controlled in the near future. At the same time, the variety of therapeutic options as well as the number of concomitant comorbidities makes the complex therapy of chronic heart failure more difficult than ever. This review aims to provide an update and practical support on the recent pharmacotherapeutic options in chronic heart failure.

Schlüsselwörter

Herzinsuffizienz - Pharmakotherapie - Prognose

Key words

heart failure - guidelines - medical therapy - device-based therapy


Publication History

Article published online:
24 September 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Ponikowski P, Voors AA, Anker SD. et al 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129-2200 . doi:10.1093/eurheartj/ehw128
    CrossrefPubMedGoogle Scholar
  • 2 Triposkiadis F, Butler J, Abboud FM. et al The continuous heart failure spectrum: moving beyond an ejection fraction classification. Eur Heart J 2019; 40: 2155-2163 . doi:10.1093/eurheartj/ehz158
    CrossrefPubMedGoogle Scholar
  • 3 Lund LH, Claggett B, Liu J. et al Heart failure with mid-range ejection fraction in CHARM: characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum. Eur J Heart Fail DOI: 10.1002/ejhf.1149.
    CrossrefPubMedGoogle Scholar
  • 4 Halliday BP, Wassall R, Lota AS. et al Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial. Lancet 2019; 393: 61-73 . doi:10.1016/S0140-6736(18)32484-X
    CrossrefPubMedGoogle Scholar
  • 5 Mullens W, Damman K, Harjola VP. et al The use of diuretics in heart failure with congestion – a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21: 137-155 . doi:10.1002/ejhf.1369
    CrossrefPubMedGoogle Scholar
  • 6 Jhund PS, McMurray JJ. The neprilysin pathway in heart failure: a review and guide on the use of sacubitril/valsartan. Heart 2016; 102: 1342-1347 . doi:10.1136/heartjnl-2014-306775
    CrossrefPubMedGoogle Scholar
  • 7 Packer M, Califf RM, Konstam MA. et al Comparison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE). Circulation 2002; 106: 920-926 . doi:10.1161/01.cir.0000029801.86489.50
    CrossrefPubMedGoogle Scholar
  • 8 McMurray JJ, Packer M, Desai AS. et al Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371: 993-1004 . doi:10.1056/NEJMoa1409077
    CrossrefPubMedGoogle Scholar
  • 9 Velazquez EJ, Morrow DA, DeVore AD. et al Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med 2019; 380: 539-548 . doi:10.1056/NEJMoa1812851
    CrossrefPubMedGoogle Scholar
  • 10 Wachter R, Senni M, Belohlavek J. et al Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail 2019; 21: 998-1007 . doi:10.1002/ejhf.1498
    CrossrefPubMedGoogle Scholar
  • 11 Solomon SD, McMurray JJV, Anand IS. et al Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. N Engl J Med 2019; 381 (17) 1609-1620 . doi:10.1056/NEJMoa1908655
    CrossrefPubMedGoogle Scholar
  • 12 Solomon SD, Claggett B, Lewis EF. et al Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J 2016; 37: 455-462 . doi:10.1093/eurheartj/ehv464
    CrossrefPubMedGoogle Scholar
  • 13 Pfeffer MA, Claggett B, Assmann SF. et al Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. Circulation 2015; 131: 34-42 . doi:10.1161/CIRCULATIONAHA.114.013255
    CrossrefPubMedGoogle Scholar
  • 14 Yancy CW, Jessup M, Bozkurt B. et al 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol 2017; 70: 776-803 . doi:10.1016/j.jacc.2017.04.025
    CrossrefPubMedGoogle Scholar
  • 15 Seferovic PM, Ponikowski P, Anker SD. et al Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; DOI: 10.1002/ejhf.1531.
    CrossrefPubMedGoogle Scholar
  • 16 Rosano GMC, Tamargo J, Kjeldsen KP. et al Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother 2018; 4: 180-188 . doi:10.1093/ehjcvp/pvy015
    CrossrefPubMedGoogle Scholar
  • 17 Cleland JG, Abraham WT, Linde C. et al An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 2013; 34: 3547-3556 . doi:10.1093/eurheartj/eht290
    CrossrefPubMedGoogle Scholar
  • 18 Anker SD, Kirwan BA, van Veldhuisen DJ. et al Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail 2018; 20: 125-133 . doi:10.1002/ejhf.823
    CrossrefPubMedGoogle Scholar
  • 19 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: 31-39 . doi:10.1016/S0140-6736(18)32590-X
    CrossrefPubMedGoogle Scholar
  • 20 McMurray JJV, Docherty KF, Jhund PS. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. Reply. N Engl J Med 2020; 382: 973 . doi:10.1056/NEJMc1917241
    PubMedGoogle Scholar
  • 21 Santos-Gallego CG, Requena-Ibanez JA, San Antonio R. et al Empagliflozin Ameliorates Adverse Left Ventricular Remodeling in Nondiabetic Heart Failure by Enhancing Myocardial Energetics. J Am Coll Cardiol 2019; 73: 1931-1944 . doi:10.1016/j.jacc.2019.01.056
    CrossrefPubMedGoogle Scholar
  • 22 Cosentino F, Grant PJ, Aboyans V. et al 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020; 41: 255-323 . doi:10.1093/eurheartj/ehz486
    CrossrefPubMedGoogle Scholar
  • 23 Armstrong PW, Pieske B, Anstrom KJ. et al Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2020; 382 (20) 1883-1893 . doi:10.1056/NEJMoa1915928
    CrossrefPubMedGoogle Scholar