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. 2018 Feb 23;115(8):124-130.
doi: 10.3238/arztebl.2018.0124.

Chronic Heart Failure

Frank Edelmann  1 , Christoph Knosalla, Klaus Mörike, Christiane Muth, Peggy Prien, Stefan Störk
Affiliations

Chronic Heart Failure

Frank Edelmann et al. Dtsch Arztebl Int. .

Abstract

Background: Chronic heart failure (CHF) is the most common reason for hospital admissions in Germany. For the National Disease Management Guideline (NDMG) on CHF, a multidisciplinary expert panel revised the chapters on drug therapy, invasive therapy, and care coordination, following the methods of evidence-based medicine.

Methods: Recommendations are based on international guideline adaptations or systematic literature search. They were developed by a multidisciplinary expert panel, approved in a formal consensus procedure, and tested in open consultation, as specified by the requirements for S3 guidelines.

Results: The pharmacological treatment is based on ACE inhibitors, beta-blockers and mineralocorticoid receptor antagonists as well as diuretics to treat fluid retention, if present. Sacubitril/Valsartan and ivabradine showed positive effects on mortality in large but methodologically limited RCT. They are recommended if established combination therapy is not sufficient for symptom control, or if drugs are not tolerated/contraindicated. The indications for pacemakers or defibrillators have been confined to patient subgroups in which clinical trials have shown a clear benefit. Moreover, the goals of treatment and the patient's expectations should be aligned with each other. Structured care programs, specialized nurses, remote, or telephone monitoring showed moderate effects on patient related outcomes in RCT.

Conclusion: All patients with heart failure are suggested to be enrolled in a structured program (e.g., a disease management program) including coordinated multidisciplinary care and continuous educational interventions. In patients with a poor prognosis, more intensive care is recommended, e.g. specialized nurses, or telephone support.

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Figures

Figure
Figure
PRISMA flow chart of literature search for structured care programs for patients with chronic heart failure
See this image and copyright information in PMC

Comment in

  • No Drawbacks for Digitoxin.
    Tauchnitz C. Tauchnitz C. Dtsch Arztebl Int. 2018 Apr 20;115(16):285. doi: 10.3238/arztebl.2018.0285a. Dtsch Arztebl Int. 2018. PMID: 29739498 Free PMC article. No abstract available.

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