Current Drug Therapy in Chronic Heart Failure: the New Guidelines of the European Society of Cardiology (ESC)

Abstract

Congestive heart failure (HF) is a morbidity that is increasing worldwide due to the aging population and improvement in (acute) care for patients with cardiovascular diseases. The prognosis for patients with HF is very poor without treatment. Furthermore, (repeated) hospitalizations for cardiac decompensation cause an increasing economic burden. Modern drugs and the consequent implementation of therapeutic recommendations have substantially improved the morbidity and mortality of HF patients. This paper provides an overview of the current pharmacological management of HF patients, based on the 2016 guidelines of the European Society of Cardiology (ESC).

Keywords: Angiotensin receptor-neprilysin inhibitor; Drug therapy; Heart failure; Standards.

Figure 1

Main results including study endpoints and adverse events, of the PARADIGM-HF trial, comparing the ARNI sacubitril/valsartan to the ACEI enalapril (adapted from23)) ACEI = angiotensin converting enzyme inhibitor; ARNI: angiotensin receptor-neprilysin inhibitor; PARADIGM-HF = Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure.

Figure 2

(A) Mode of action of empagliflozin, a SGLT2 inhibitor, in the kidneys. (B) The main results of the EMPA-REG trial on cardiovascular outcomes in patients with type 2 diabetes (adapted from30)). EMPA-REG = Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients; HF = heart failure; n.s. = not significant; SGLT2 = sodium-glucose cotransporter-2. ^*Death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, ^†Excluding fatal stroke, ^‡p value for test of superiority.