{"id":358441,"date":"2023-06-13T14:00:00","date_gmt":"2023-06-13T12:00:00","guid":{"rendered":"https:\/\/medizinonline.com\/pharmacotherapy-in-hfref-and-hfmref-combination-of-four-as-gold-standard\/"},"modified":"2023-07-19T17:17:08","modified_gmt":"2023-07-19T15:17:08","slug":"pharmacotherapy-in-hfref-and-hfmref-combination-of-four-as-gold-standard","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/pharmacotherapy-in-hfref-and-hfmref-combination-of-four-as-gold-standard\/","title":{"rendered":"Pharmacotherapy in HFrEF and HFmrEF – Combination of four as gold standard."},"content":{"rendered":"\n

Important therapeutic goals in chronic heart failure are to improve quality of life and to reduce the risk of hospitalization and mortality. According to current evidence, guideline-based therapy with the four drug groups ACE inhibitors\/ARNIs, beta blockers, mineralocorticoid receptor antagonists and SGLT-2 inhibitors achieves the best effects. This has been proven in various studies.<\/strong><\/p>\n\n\n\n

The prevalence of heart failure in the general population varies with age group. While in <55-J\u00e4hrigen bei etwa 1% liegt, sind bei>70-year-olds, they are more than 10% affected by heart failure. Women are affected slightly more often. If left untreated, heart failure patients have a significant mortality risk [1,2]. Maren Weferling, MD, Kerckhoff Klinik, Bad Nauheim, Germany, explained that heart failure is most frequently associated with coronary heart disease (CHD) and hypertension [1]. Other causes of heart failure range from cardiomyopathies to arrhythmias, storage diseases, and myocarditis to vitiation and thoracic radiation. But cardiotoxic drugs (e.g., chemotherapy, checkpoint inhibitors) and drug abuse (e.g., cocaine) also increase the risk for heart failure, the speaker explained. <\/p>\n\n

NT-proBNP\/BNP: high negative predictive value. <\/h3>\n\n

Heart failure is a clinical syndrome with symptoms and, when appropriate, signs of heart failure that may be due to structural or functional damage to the heart [1,2]. According to Dr. Weferling [1], if a patient’s history and\/or physical examination and\/or ECG substantiates a suspicion of heart failure, the recording of cardiac congestion parameters is indicated ( Fig. 1)<\/strong>. NT-proBNP\/BNP is a parameter with a very high negative predictive value. Subsequent echocardiography is required only if NT-proBNP\/BNP values are elevated. The classification of heart failure is based on the ejection fraction (EF): if the EF is below 40%, it is considered reduced (HFrEF, Heart Failure with Reduced Ejection Fraction),<\/em> If the EF is \u226550%, it is considered to be preserved (HFpEF, Heart Failure with preserved Ejection Fraction) <\/em>and the area in between is assigned to the HFmrEF (Heart Failure with Mildly Reduced Ejection Fraction)<\/em> attributed. <\/p>\n\n

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Therapy with the “Fantastic Four” is considered the gold standard nowadays <\/h3>\n\n

In HFrEF as well as in HFmrEF, the use of the “Fantastic Four” is propagated nowadays, i.e., one representative of each of the following groups of agents is applied simultaneously or in quick succession (Fig. 2) <\/strong>[2]: <\/p>\n\n