Development of the strategy of pharmacotherapy of chronic heart failure at the present stage
https://doi.org/10.21626/vestnik/2024-3/05
EDN: LMLDPG
Abstract
Objective - to present a review of literature data concerning the main stages of changing the paradigm of prognosis-modifying pharmacotherapy for patients with chronic heart failure. The article discusses the dynamics of the pharmacological treatment strategy for patients with chronic heart failure (CHF) with different left ventricular ejection fractions. Changes in pharmacotherapeutic approaches to the use of prognosis-modifying drugs are based on randomized clinical trials completed in recent years, which have shown the significant contribution of sodium-glucose cotransporter-2 inhibitor (SGLT2i) in reducing the risk of developing negative outcomes in patients with heart failure with reduced left ventricular ejection fraction (СHFrEF), mildly reduced (CHFmrEF) and preserved ejection fraction (CHFpEF). Currently, in patients with symptomatic CHFrEF, the priority is quadruple therapy, including one of the blockers of the renin-angiotensin-aldosterone system (angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-receptor blocker (ARB), angiotensin receptors-neprilysin inhibitor (ARNI) - preferably ARNI or ACE-I); beta-blocker (BB); mineralocorticoid receptor antagonist (MRA); SGLT2i. In patients with CHFmrEF and CHFpEF, the highest class of recommendations is given to SGLT2i and diuretics (in the presence of congestion), while ARNI/ACE-I/ARB, MRA, BB were assigned a lower class - IIb - in patients with CHFmrEF. In patients with CHFpEF, SGLT2i and diuretics (if necessary) can be rationally combined with ARNI, MRA, ARB (if ARNI are intolerant).
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For citations:
Povetkin S.V. Development of the strategy of pharmacotherapy of chronic heart failure at the present stage. Humans and their health. 2024;27(3):51-58. (In Russ.) https://doi.org/10.21626/vestnik/2024-3/05. EDN: LMLDPG
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