[New therapeutic approaches in heart failure]

Abstract

Chronic heart failure is one of the most common causes of death in western countries. For heart failure with preserved systolic function thus far no reduction of mortality or morbidity could be demonstrated in clinical trials. Conversely, prognosis of systolic heart failure has been improved by the introduction of various drugs and devices in recent years. Since the publication of the latest heart failure guidelines, additional results from clinical studies have been obtained, which should be considered in patient treatment. In patients with severe systolic dysfunction the addition of low dose aldosterone antagonists to an ACE inhibitor and betablocker reduced mortality and hospitalizations already in functional class NYHA II. A resting heart rate above 70 bpm is an independent risk factor in systolic heart failure. If this high heart rate persists despite the maximal tolerated betablocker dose, isolated heart rate reduction by ivabradine may lower the rate of hospital admissions due to worsening heart failure. Iron deficiency should be substituted independently of the presence of anemia to improve symptoms and exercise capacity. In patients with severe systolic dysfunction (ejection fraction < 30 %) and a wide QRS complex ≥ 150 ms cardiac resynchronization therapy (CRT) may be considered even when only mild symptoms are present to reduce hospitalizations.