Materiały źródłowe

• #1 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  Treatment of heart failure may depend on the cause. Treatment often includes lifestyle changes and medicines. If another health condition is causing the heart to fail, treating it may reverse heart failure. […] Some people with heart failure need surgery to open blocked arteries or to place a device to help the heart work better. […] With treatment, symptoms of heart failure may improve. […] A combination of medicines may be used to treat heart failure. The specific medicines used depend on the cause of heart failure and the symptoms. […] Your healthcare professional may need to change your medicine doses frequently. This is more common when you’ve just started a new medicine or when your condition is getting worse. […] You may need to stay in the hospital if you have a flare-up of heart failure symptoms. While in the hospital, you may receive: Medicines to relieve your symptoms. More medicines to help your heart pump better. Oxygen through a mask or small tubes placed in your nose.

• #1 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  Surgery or other treatment to place a heart device may be recommended to treat the condition that led to heart failure. […] Some people have such severe heart failure that surgery or medicines don’t help. These people may need to have their hearts replaced with a healthy donor heart. […] Your healthcare professional may recommend special medical care to reduce symptoms and improve quality of life. This is called palliative care. […] If you have an ICD, one important consideration to discuss with your family and healthcare team is whether the ICD should be turned off so that it can’t deliver shocks to make your heart continue beating.

• #2 Heart Failure – Treatment | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/heart-failure/treatment

  Heart failure has no cure. But treatment can help you live a longer, more active life with fewer symptoms. Treatment depends on the type of heart failure you have and how serious it is. […] Your provider may recommend these heart-healthy lifestyle changes alone or as part of a cardiac rehabilitation plan: […] The following medicines are commonly used to treat heart failure with reduced ejection fraction. […] Currently, the main treatments for heart failure with preserved ejection fraction are diuretics. Your doctor also may prescribe blood pressure medicines to help relieve your symptoms. […] If you have heart failure with reduced ejection fraction and it worsens, you may need one of the following medical devices: […] For people with heart failure and preserved ejection fraction, there are no currently approved devices or procedures to improve symptoms. Researchers are continuing to study possible treatments.

• #3 Treatment Options for Heart Failure | American Heart Association

  https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure

  Heart failure caused by damage to the heart that has developed over time can’t be cured, but it can be treated, often with strategies to improve symptoms. […] Successful treatment depends on your willingness to get involved in managing the condition. […] Your treatment plan will likely include: Lifestyle changes, Medications, Devices and surgical procedures, Ongoing care. […] Regardless of your treatment approach, you should follow all of your health care professional’s recommendations and make the necessary changes in your eating, exercise and lifestyle to give you the highest possible quality of life.

• #4 Overview of the management of heart failure with reduced ejection fraction in adults – UpToDate

  https://www.uptodate.com/contents/overview-of-the-management-of-heart-failure-with-reduced-ejection-fraction-in-adults

  Overview of the management of heart failure with reduced ejection fraction in adults […] An overview of the management of chronic HFrEF in nonpregnant patients is presented here. […] The goals of therapy of HFrEF are to reduce morbidity (ie, reduce symptoms, improve health-related quality of life and functional status, and decrease the rate of hospitalization), and to reduce mortality. […] Management of HFrEF includes management of the cause of HF and associated conditions, monitoring, preventative care, care coordination, education and support for HF self-management (including lifestyle modification and daily monitoring), pharmacologic therapy, cardiac rehabilitation, palliative care, device therapy (including cardiac resynchronization therapy, implantable cardioverter defibrillator, and mechanical circulatory support [eg, LV assist device]) and cardiac transplantation.

• #5 Medications Used to Treat Heart Failure | American Heart Association

  https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure

  Studies have shown that some classes of drugs are best for treating heart failure. […] The goal of heart failure treatment is to improve your quality of life and help you live longer. Treating heart failure with medication can reduce fatigue, shortness of breath and fluid retention. […] People with heart failure need multiple medications. Each treats a different symptom or contributing factor and comes with its own instructions. These medications work together to improve overall heart function. […] You and your caregivers should work with your health care team to understand the medications. This includes the dose and when and how often to take them. […] It is important never to stop taking your medications and never to change how you take them without first talking to your health care professional or pharmacist.

• #5 Medications Used to Treat Heart Failure | American Heart Association

  https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure

  ACE inhibitors and ARBs lower blood pressure by widening blood vessels. This reduces the heart’s workload and helps keep heart failure from getting worse. […] Sacubitril/valsartan (Entresto) takes the place of an ACE inhibitor or an ARB. […] Beta-blockers prevent the heart from beating too quickly and forcefully. […] Aldosterone antagonists (also called mineralocorticoid receptor antagonists or MRAs) are a type of water pill that also help to lower high blood pressure. […] Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve blood sugar control and may decrease body weight and blood pressure. […] These medications are vasodilators, which widen blood vessels. […] Diuretics or “water pills” cause the body to rid itself of excess fluids and sodium through urination. […] Ivabradine (Corlanor) This medication is known as an If channel blocker.

• #5 Medications Used to Treat Heart Failure | American Heart Association

  https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure

  Digoxin (Lanoxin) This medication might strengthen the heart’s pumping action and reduce a heart rate that’s too fast. […] Vericiguat (Verquvo) This medication is known as a soluble guanylate cyclase (SGc) inhibitor. […] Your health care professional may also prescribe other medications for additional health conditions that may occur with heart failure.

• #6 Heart Failure Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy

  https://emedicine.medscape.com/article/163062-treatment

  Four core foundational medication classes (SGLT2Is, beta blockers, MRAs, and renin-angiotensin system [RAF] inhibitors) are now included in guideline-directed medical therapy (GDMT) for HF with reduced EF (HFrEF). […] Patients with previous HFrEF who now have an left ventricular (LV) EF above 40% should be referred to as having improved LVEF; they should continue their HFrEF treatment. […] Heart transplantation is recommended for patients who have advanced HF that is refractory to medical/device therapy and who do not have absolute contraindications. […] Heart transplantation has been the criterion standard for therapy when progressive end-stage heart failure occurs despite maximal medical therapy, when the prognosis is poor, and when there is no viable therapeutic alternative. […] Treatment of cardiorenal syndrome in patients with heart failure is largely empirical, but it typically involves the use of combination diuretics, vasodilators, and inotropes as indicated.

• #6 Heart Failure Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy

  https://emedicine.medscape.com/article/163062-treatment

  Patients with heart failure should be evaluated for coronary artery disease, which can lead to heart failure. […] Valvular heart disease may be the underlying etiology or an important aggravating factor in heart failure. […] Patients with heart failure can benefit from attention to exercise, diet, and nutrition. […] Diuretics remain the cornerstone of standard therapy for acute heart failure. […] Diuretics can be given by bolus or continuous infusion and in high or low doses. […] The 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America guideline’s new treatment recommendations for HFpEF (LVEF 50%) include diuretics (class 1) and sodium-glucose cotransporter-2 (SGLT2) inhibitors (class 2a). […] The guideline indicates no benefit for the routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or quality of life, as well as for the routine use of nutritional supplements in HFpEF.

• #6 Heart Failure Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy

  https://emedicine.medscape.com/article/163062-treatment

  The prognosis in patients with RV failure depends on the etiology. […] The prognosis in patients with RV failure depends on the etiology. […] In selected patients with heart failure, a reduced ejection fraction (EF 35%), and acceptable coronary anatomy, surgical revascularization in addition to guideline-directed medical therapy (GDMT) aids in improvement of symptoms, cardiovascular hospitalizations, and long-term all-cause mortality. […] Surgical revascularization prolonged survival to a greater degree than did medical therapy in most clinical and angiographic subgroups in the Coronary Artery Surgery Study (CASS) of patients with left main equivalent disease.

• #7 Four pillars of heart failure therapy should be rapidly and simultaneously introduced | Medical Professionals

  https://blog.bswhealth.med/four-pillars-of-heart-failure-therapy-should-be-rapidly-and-simultaneously-introduced/

  Four pillars of heart failure therapy should be rapidly and simultaneously introduced. Management of patients with heart failure with reduced ejection fraction consists of a combination of older, tried-and-true medications and recently developed, novel pharmacological therapies. Known as the four pillars of heart failure therapy, these medications are beta blockers, angiotensin receptor-neprilysin inhibitors (ARNIs), mineralcorticoid receptor antagonists (MRAs) and sodium-glucose co-transporter 2 Inhibitors (SGLT2i). The latest clinical evidence shows patients with heart failure should be put on these drugs all at once. […] The newest recommendation for patients with heart failure, whether hospitalized or outpatient, is to start patients on all four drug classes at the same time and rapidly and aggressively titrate to maximum tolerated dose.

• #8 It’s time to get heart failure patients the medications they need | Heart | UT Southwestern Medical Center

  https://utswmed.org/medblog/heart-failure-medications/

  The four pillar heart failure medications for patients with HFrEF build on each other to optimize a patients heart function. […] For patients with heart failure with reduced ejection fraction (HFrEF), four foundational medications have been proven to substantially decrease hospitalizations and improve survival rates and patient-reported quality of life. […] One of the key recommendations in those updated guidelines was the addition of SGLT2 inhibitors to three other medications previously recommended to treat patients with HFrEF. […] With this addition, a combination of four medications was recommended and is now affectionately known as the Fantastic Four: ARNI (or ACE/ARB), Beta blockers, Mineralocorticoid receptor antagonists (MRAs), Sodium-glucose cotransporter-2 inhibitors (SGLT2i).

• #8 It’s time to get heart failure patients the medications they need | Heart | UT Southwestern Medical Center

  https://utswmed.org/medblog/heart-failure-medications/

  If a patient takes all of the four types of medications included in GDMT, they can reduce the risk of dying over two years by an estimated 73%! […] The benefits of all four medications are additive, which means each one gives additional benefit to the patient. […] The STRONG-HF trial demonstrated that the strategy of starting medicines at the same time and increasing the doses rapidly was effective. […] Every eligible patient with heart failure with reduced ejection fraction should be on all four medications, unless they have a documented contraindication. […] Getting the right medications and right doses can give you added support and years of happier, healthier life.

• #8 It’s time to get heart failure patients the medications they need | Heart | UT Southwestern Medical Center

  https://utswmed.org/medblog/heart-failure-medications/

  These four pillars of guideline-directed medical therapy (GDMT) are game changers for patients. […] Despite a substantial body of research showing the benefits of GDMT, implementation has remained stagnant, and many patients dont get the treatment they need. […] Even hospitalization a pivotal moment in the trajectory of a patient with heart failure does not seem to change this troubling trend. […] Education for both patients and providers about the long-term benefits of GDMT is a potential area for improvement. […] At UT Southwestern, our heart failure specialists put a premium on getting patients on GDMT quickly and titrating them up to the proper dosage for long-term benefits. […] GDMT has been proven to extend survival, decrease risk of being admitted to the hospital, and improve symptoms so that patients feel better.

• #9 Contemporary pharmacological treatment and management of heart failure | Nature Reviews Cardiology

  https://www.nature.com/articles/s41569-024-00997-0

  The prevention and treatment strategies for heart failure (HF) have evolved in the past two decades. […] The first-line treatment of patients with HF with reduced ejection fraction includes foundational therapies with angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, -blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors and diuretics. […] The timely initiation of these disease-modifying therapies and the optimization of treatment are crucial in all patients with HF. […] Lifestyle modification and treatment of comorbidities such as diabetes mellitus, ischaemic heart disease and atrial fibrillation are crucial through each stage of HF. […] The first-line treatment of patients with HF with mildly reduced ejection fraction or with HF with preserved ejection fraction includes SGLT2 inhibitors and diuretics.

• #10 Heart failure with reduced ejection fraction: What’s new in the 2022 guideline? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/4/215

  The 2022 guideline from the American College of Cardiology, American Heart Association, and Heart Failure Society of America provides practical recommendations for preventing, diagnosing, and managing patients with heart failure. This article summarizes the most important of these recommendations, specifically for managing patients with heart failure with reduced ejection fraction (HFrEF), and how they should change daily practice. […] Optimal guideline-directed medical therapy for HFrEF comprises the combination drug containing the neprilysin inhibitor sacubitril and the angiotensin II receptor blocker (ARB) valsartan; an evidence-based beta-blocker; a mineralocorticoid antagonist; and a sodium-glucose cotransporter 2 inhibitor. […] Sacubitril-valsartan is preferred over angiotensin-converting enzyme (ACE) inhibitors and ARBs based on evidence from randomized controlled trials that it increases survival rates and reduces hospitalizations in patients with HFrEF.

• #10 Heart failure with reduced ejection fraction: What’s new in the 2022 guideline? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/4/215

  In patients with HFrEF with current or previous symptoms, use of 1 of the 3 beta-blockers proven to reduce mortality risk (bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended to reduce mortality risk and hospitalizations (class 1 recommendation). […] In patients with HFrEF and class II to IV symptoms, a mineralocorticoid antagonist (spironolactone or eplerenone) is recommended to reduce morbidity and mortality, if the estimated glomerular filtration rate is higher than 30 mL/min/1.73 m2 and the serum potassium level is less than 5.0 mmol/L. […] Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are recommended in patients with symptomatic chronic HFrEF to reduce hospitalizations for heart failure and cardiovascular mortality, regardless of whether the patient has type 2 diabetes (class 1 recommendation).

• #10 Heart failure with reduced ejection fraction: What’s new in the 2022 guideline? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/4/215

  Patients with HFrEF receiving guideline-directed medical therapy whose ejection fraction increases to more than 40% should continue to receive guideline-directed medical therapy. […] Stage C heart failure with reduced ejection fraction (HFrEF) in particular, there is a wealth of evidence-based and guideline-based medical therapy to help patients feel better, stay out of the hospital, live longer, and potentially improve left ventricular function. […] Sacubitril-valsartan is recommended in patients with HFrEF and New York Heart Association (NYHA) class II or III symptoms to reduce morbidity and mortality (class 1 recommendation). […] Even if a patient with chronic HFrEF and class II or III symptoms is already receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) and tolerating it well, replacing it with sacubitril-valsartan is recommended to further reduce morbidity and mortality (class 1 recommendation).

• #10 Heart failure with reduced ejection fraction: What’s new in the 2022 guideline? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/4/215

  There is now a class 1 recommendation that patients with heart failure with improved ejection fraction after treatment should continue guideline-directed medical therapy to prevent relapse of heart failure and left ventricular dysfunction, even patients whose symptoms have gone away. […] Ivabradine is not a substitute for a beta-blocker. It has not been tested and found, by itself, to reduce the mortality rate, whereas beta-blockers have. Rather, ivabradine is an adjunctive therapy, to be added to the regimen in those who have a heart rate 70 beats per minute or more despite maximum-tolerated evidence-based beta-blocker therapy.

• #10 Heart failure with reduced ejection fraction: What’s new in the 2022 guideline? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/4/215

  If the ejection fraction improves after treatment, guideline-directed medical therapy should be continued to prevent relapse of heart failure and left ventricular dysfunction, even in patients who no longer have symptoms (class 1 recommendation). […] For patients self-identified as Black with class III or IV symptomatic HFrEF who are receiving optimal medical therapy, the combination of hydralazine and isosorbide dinitrate is recommended to improve symptoms and reduce morbidity and mortality (class 1 recommendation). […] The 2022 guideline reflects these advances, providing a class 1 recommendation for sacubitril-valsartan over an ACE inhibitor or ARB in patients with chronic symptomatic HFrEF. […] The 2022 guideline also highlights the importance of comprehensive guideline-directed medical therapy for HFrEF with sacubitril-valsartan, an evidence-based beta-blocker, a mineralocorticoid antagonist, and an SGLT-2 inhibitor.

• #11 The most effective combination of pharmacological therapy for heart failure with reduced ejection fraction: a network meta-analysis of randomized controlled trials | BMC Cardiovascular Disorders | Full Text

  https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-024-04339-3

  Evidence for the efficacy of pharmacological therapies for heart failure with reduced ejection fraction (HFrEF) is growing. However, there is no consensus on the most effective treatment for HFrEF. This study aimed to evaluate the most effective combination of pharmacological therapy in patients with HFrEF. […] For reducing all-cause mortality, the combination of angiotensin-converting enzyme inhibitors (ACEI), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose co-transporter-2 inhibitors (SGLT2i) was most effective (RR, 0.46; 95% CI, 0.320.66). For CV death, the combination of ACEI, BB, MRA, and Vericiguat showed the highest efficacy (RR, 0.34; 95% CI, 0.120.90). Regarding reducing HHF, the combination of ACEI, BB, MRA, and SGLT2i as well as the combination of ACEI, BB, MRA, and Ivabradine were equally the most effective (both RR, 0.27; 95% CI, 0.180.39).

• #11 The most effective combination of pharmacological therapy for heart failure with reduced ejection fraction: a network meta-analysis of randomized controlled trials | BMC Cardiovascular Disorders | Full Text

  https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-024-04339-3

  This study provides robust evidence supporting the use of combination therapies in HFrEF management, with newer agents offering incremental benefits when added to established guideline-directed medical therapy. […] More recent developments including sodium-glucose co-transporter-2 inhibitors (SGLT2i), ivabradine, and Hydralazine and Isosorbide Dinitrate (H-ISDN) have significantly advanced clinical practices by decreasing the morbidity and mortality in high-risk patients with HFrEF. […] Clinical trials such as DAPA-HF and EMPEROR-Reduced found the risk of hospitalization was decreased by more than 30% and the risk of cardiovascular (CV) death was decreased by 14% utilizing SGLT2i marking their importance in the management of HFrEF. […] Angiotensin II converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), or angiotensin II receptor-neprilysin inhibitors (ARNI) remain recommended by AHA/ACC/HFSA guidelines and CCS/CHFS guidelines as first-line therapy for patients with HFrEF to reduce morbidity and mortality.

• #12 FDA approves new treatment for a type of heart failure | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-type-heart-failure

  Today, the U.S. Food and Drug Administration approved Farxiga (dapagliflozin) oral tablets for adults with heart failure with reduced ejection fraction to reduce the risk of cardiovascular death and hospitalization for heart failure. […] This approval provides patients with heart failure with reduced ejection fraction an additional treatment option that can improve survival and reduce the need for hospitalization. […] Farxiga was shown in a clinical trial to improve survival and reduce the need for hospitalization in adults with heart failure with reduced ejection fraction. […] After about 18 months, people who received Farxiga had fewer cardiovascular deaths, hospitalizations for heart failure, and urgent heart failure visits than those receiving the placebo. […] Farxiga is also FDA-approved to improve glycemic control in adults with type 2 diabetes in addition to diet and exercise, and to reduce the risk of hospitalization for heart failure among adults with type 2 diabetes and known cardiovascular disease or other risk factors.

• #13 Treatment of Heart Failure | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602727/all/Treatment_of_Heart_Failure

  SGLT2 inhibitors promote osmotic diuresis and natriuresis and exert beneficial pleiotropic effects on the heart, vasculature, and metabolic profile. […] Dapagliflozin and empagliflozin have been shown to decrease cardiovascular mortality and HF hospitalizations when added to standard therapy in patients with HFrEF with or without diabetes. […] Diuretic therapy in conjunction with restriction of dietary sodium and fluids often leads to clinical improvement in patients with symptomatic HF. […] Complications of therapy include hypokalemia, hyponatremia, hypomagnesemia, volume contraction alkalosis, intravascular volume depletion, and hypotension. […] Second-line therapies In patients who have ongoing symptoms despite maximization of the four cornerstone medications mentioned above or have intolerance/contraindications preventing use of certain agents, additional therapies may provide benefit.

• #13 Treatment of Heart Failure | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602727/all/Treatment_of_Heart_Failure

  -Blockers are a critical component of HF therapy and work by blocking the effects of chronic adrenergic stimulation on the heart. […] Large randomized trials have documented the beneficial effects of -blockers on functional status, disease progression, and survival in patients with NYHA class IIIV symptoms. […] Typically, 23 months of therapy is required to observe significant effects on LV function, but reduction of cardiac arrhythmia and incidence of sudden cardiac death (SCD) may occur much earlier. […] The survival benefit of -blockers is proportional to the heart rate reduction and dosage achieved. […] Individual -blockers have unique properties, and the beneficial effects of -blockers are not a class effect. […] Therefore, one of the three -blockers with proven benefit on mortality in large clinical trials should be used: Carvedilol, Metoprolol succinate, Bisoprolol.

• #13 Treatment of Heart Failure | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602727/all/Treatment_of_Heart_Failure

  Sacubitril/valsartan is a combination of the neprilysin inhibitor (sacubitril) and ARB (valsartan). […] Neprilysin is a neutral endopeptidase involved in the degradation of vasoactive peptides including the natriuretic peptides, bradykinin, and adrenomedullin. […] Inhibition of neprilysin increases the availability of these peptides, which exert favorable effects in HF. […] Sacubitril/valsartan was shown to be superior to enalapril in reducing death and rehospitalization among NYHA class IIIV patients with HFrEF who were stably tolerant of ACE inhibitor or ARB therapy. […] ACE inhibitors and ARBs target the compensatory RAAS activation and attenuate vasoconstriction, vital organ hypoperfusion, hyponatremia, hypokalemia, and fluid retention. […] These medications should be used as second-line therapy if patients cannot tolerate or afford ARNI.

• #13 Treatment of Heart Failure | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602727/all/Treatment_of_Heart_Failure

  Vericiguat was shown to reduce cardiovascular death and HF hospitalization in patients with HFrEF and worsening symptoms or recent decompensation. […] Ivabradine was shown to reduce HF hospitalization and HF death in outpatients with HFrEF and is indicated for the reduction of HF hospitalization in patients with EF 35%, stable HF symptoms, and sinus rhythm with a resting heart rate 70 bpm who are already taking -blockers at the highest tolerated dose. […] Digoxin has been shown to decrease rates of HF hospitalizations without improving overall mortality. […] Discontinuation of digoxin in patients who are stable on a regimen of digoxin, diuretics, and an ACE inhibitor may result in clinical deterioration. […] Therapies with unproven benefit -Adrenergic receptor antagonists have not been shown to improve survival in HF, and hypertensive patients treated with doxazosin as first-line therapy are at increased risk of developing HF.

• #14 Drug Treatment for Heart Failure – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/heart-failure/drug-treatment-for-heart-failure

  It is important for people to take their drugs regularly and be sure not to let the prescription run out. […] Aldosterone antagonists (blockers) directly block the effects of aldosterone and help limit fluid retention. These drugs improve survival and reduce hospitalization in people with heart failure. […] ACE inhibitors thus help limit fluid retention and are one of the mainstays of systolic heart failure treatment. These drugs not only reduce symptoms and the need for hospitalization but also prolong life. […] Angiotensin II receptor blockers (ARBs) have effects similar to those of ACE inhibitors. […] Angiotensin receptor/neprilysin inhibitors (ARNIs) are a newer combination drug for the treatment of heart failure. […] Beta-blockers are often used with ACE inhibitors to treat heart failure and are another mainstay of heart failure treatment.

• #14 Drug Treatment for Heart Failure – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/heart-failure/drug-treatment-for-heart-failure

  Digoxin helps relieve symptoms for some people with systolic heart failure but, unlike other heart failure drugs discussed here, it does not prolong life. […] Diuretics help the kidneys eliminate salt and water by increasing urine formation and thus decreasing fluid volume throughout the body. […] Loop diuretics are the diuretics most commonly used for heart failure. […] For all people with heart failure, spironolactone is the preferred potassium-sparing diuretic and can be used unless kidney function is severely reduced. It can prolong life in people with heart failure. […] Ivabradine is the first drug in this class of drugs that slow down the rate of the sinus node. […] Sodium-glucose cotransporter-2 inhibitors are used in the treatment of diabetes. […] Vasodilators make it easier for the heart to pump blood.

• #15 7 of the Latest Advances in Heart Failure Treatment | Flow Therapy

  https://flowtherapy.com/resource/latest-advances-in-heart-failure-treatment/

  Flow therapy effectively reduces symptom severity and improves the quality of life in patients with heart failure. However, it should not be used as a sole treatment for heart failure. Instead, it should be used in conjunction with other lifestyle changes and treatments to help manage the condition. […] Ivabradine is a new drug for heart failure that can help treat heart failure by improving the hearts pumping ability. It does this by slowing down the heart rate and increasing the amount of blood pumped with each beat. In addition, Ivabradine can help improve the quality of life for people with heart failure by reducing symptoms such as fatigue and shortness of breath. […] Sacubitril/Valsartan is a combination drug approved by the FDA in 2015. Its a combination of two medicines: sacubitril, which is an inhibitor of neprilysin, and valsartan, which is an angiotensin receptor blocker (ARB).

• #15 7 of the Latest Advances in Heart Failure Treatment | Flow Therapy

  https://flowtherapy.com/resource/latest-advances-in-heart-failure-treatment/

  Combining these two drugs leads to a significant improvement in heart function and a reduction in hospitalizations for heart failure. In addition, Sacubitril/Valsartan has reduced mortality from heart failure. […] The Heartmate 3 is a new treatment for heart failure that helps pump blood from the left ventricle of the heart. The goal of treatment with Heartmate 3 is to improve the quality of life and extend life expectancy. The device is implantable and powered by batteries. It effectively enhances heart function and reduces hospitalizations due to heart failure. It is an option for people who are not heart transplant candidates or waiting for a transplant. […] One treatment option for heart failure is Mitraclip therapy. Mitraclip is a device placed inside the heart to help it pump blood more effectively. Its typically used in people who have moderate to severe heart failure and havent been helped by other treatments like medications or lifestyle changes.

• #15 7 of the Latest Advances in Heart Failure Treatment | Flow Therapy

  https://flowtherapy.com/resource/latest-advances-in-heart-failure-treatment/

  Mitraclip therapy has improved the quality of life and exercise tolerance in people with heart failure. It can also reduce the risk of hospitalization and death from heart failure. […] The V-Wave InterAtrial Shunt Device is a new treatment for heart failure that offers hope to those who have not responded well to other therapies. The device is implanted in the heart and helps redirect blood flow, which can improve symptoms and quality of life for patients with heart failure. […] Personalized Volume Management Systems (PVM) are a new class of devices with the potential to improve management of HF by providing real-time feedback on cardiac output changes and intravascular volume status. PVM systems have improved clinical outcomes in heart failure patients, including reducing hospital admissions and mortality rates. In addition, PVM-guided therapy has been associated with improved quality of life and exercise tolerance in patients.

• #15 7 of the Latest Advances in Heart Failure Treatment | Flow Therapy

  https://flowtherapy.com/resource/latest-advances-in-heart-failure-treatment/

  Heart failure is a condition that affects millions of people worldwide. While there is no cure for heart failure, there are many advancements in treatment that can help improve the quality of life for those who suffer from it. […] Despite recent advances in treatment, heart failure remains a leading cause of morbidity and mortality. Thus, there is an urgent need to develop more effective treatments for this condition. In recent years, there have been further advances in the treatment of heart failure. Below are some of the most promising new heart failure drugs and devices: […] One treatment option for heart failure is flow therapy, also known as Enhanced External Counterpulsation (EECP). Flow therapy is a non-invasive treatment that uses sophisticated counterpulsation technology to improve blood flow and reduce congestion in the heart.

• #16

  https://link.springer.com/article/10.1007/s40256-024-00641-9

  In the chronic phase, the primary goals of HFpEF treatment are to enhance cardiac function, alleviate symptoms, and prevent long-term complications. […] ACEIs and ARBs contribute to HF management by targeting the renin-angiotensin-aldosterone system, effectively reducing blood pressure, enhancing cardiac function through afterload reduction, and relieving the heart’s workload. […] ARNI blocks the angiotensin II receptor and inhibits the breakdown of natriuretic peptides, leading to vasodilation, reduced sodium retention, and improved cardiac function. […] SGLT2 inhibitors act by inhibiting SGLT2 in the proximal tubule of the kidney, leading to increased urinary glucose excretion and subsequent reduction in blood glucose levels. […] Vericiguat, a novel oral soluble guanylate cyclase (sGC) stimulator, has shown potential in reducing HF-associated oxidative stress and improving endothelial dysfunction.

• #16

  https://link.springer.com/article/10.1007/s40256-024-00641-9

  The management of HFpEF in the acute phase with concurrent hypertension presents specific challenges, necessitating urgent or rapidly acting therapy. […] Diuretics play a crucial role in the management of HFpEF, particularly in addressing the hallmark features of abnormal fluid distribution and fluid overload. […] Aldosterone receptor blockade can be beneficial in patients with HF, as MRAs are believed to prevent many of the maladaptive effects of aldosterone on the cardiovascular system. […] Vasodilators play a vital role in the management of HFpEF by addressing the relaxation impairment (diastolic dysfunction) that is characteristic of the condition. […] Inotropes, including dobutamine and milrinone, play a role in managing severe HFpEF by enhancing cardiac contractility and increasing cardiac output.

• #17 Congestive Heart Failure: Symptoms, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure

  Treatment for people with Stage B heart failure includes: Treatments for Stage A. Angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) if your EF is 40% or lower. Beta-blocker if youve had a heart attack and your EF is 40% or lower (if you arent already taking one). Aldosterone antagonist if youve had a heart attack or if you have an EF of 35% or less. Possible surgery or intervention as a treatment for coronary artery blockage, heart attack, valve disease (valve repair or replacement) or congenital heart disease. […] Treatment for people with Stage C HFrEF includes: Treatments from Stages A and B. Beta-blocker. Aldosterone antagonist. Sodium-glucose transport 2 inhibitors (SGLT2i). Hydralazine/nitrate combination if other treatments dont stop your symptoms and youre African American. Medications that slow your heart rate if your heart rate is faster than 70 beats per minute and you still have symptoms. A diuretic (water pill) if symptoms continue. Restriction of sodium (salt) in your diet. Weight tracking every day. Tell your healthcare provider if you gain or lose more than 4 pounds. Possible fluid restriction. Possible cardiac resynchronization therapy (biventricular pacemaker). Possible implantable cardiac defibrillator (ICD) therapy.

• #17 Congestive Heart Failure: Symptoms, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure

  Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle changes are part of every heart failure treatment plan. Your healthcare provider will talk to you about the best treatment plan for you. […] Theres no cure for heart failure. As congestive heart failure gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. Since you cant move backward through the heart failure stages, the goal of treatment is to keep you from moving forward through the stages or to slow down the progression of your heart failure. […] Treatment for people with Stage A heart failure includes: Regular exercise, such as walking every day. No tobacco products. Treatment for high blood pressure (medication, low-sodium diet, active lifestyle). Treatment for high cholesterol. No alcohol or recreational drugs. Angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) if you have coronary artery disease, diabetes, high blood pressure or other vascular or cardiac conditions.

• #17 Congestive Heart Failure: Symptoms, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure

  Treatment for people who have Stage D heart failure includes treatments for Stages A, B and C. In addition, it includes evaluation for more advanced treatment options, including: Heart transplant. Ventricular assist devices. Heart surgery. Continuous infusion of inotropic drugs. Palliative or hospice care. […] Treatment for people with Stage C and Stage D heart failure and preserved EF (HFpEF) includes: Treatments for Stages A and B. Medications for the treatment of medical conditions that can cause heart failure or make it worse, such as atrial fibrillation, high blood pressure, diabetes, obesity, coronary artery disease, chronic lung disease, high cholesterol and kidney disease. Diuretic (water pill) to reduce or relieve symptoms. […] Complications of congestive heart failure treatments may include: Hypotension. Kidney failure. Infections from frequent hospital visits that involve central IVs.

• #18 Heart failure – Wikipedia

  https://en.wikipedia.org/wiki/Heart_failure

  There is no convincing evidence for pharmacological treatment of heart failure with preserved ejection fraction (HFpEF). […] Medication for HFpEF is symptomatic treatment with diuretics to treat congestion. […] Inhibitors of the renin-angiotensin system (RAS) are recommended for heart failure. […] Use of a mineralocorticoid antagonist, such as spironolactone or eplerenone, in addition to beta blockers and ACE-I, can improve symptoms and reduce mortality in people with symptomatic heart failure with reduced ejection fraction (HFrEF). […] SGLT2 inhibitors are used for heart failure with reduced ejection fraction as they have demonstrated benefits in reducing hospitalizations and mortality, regardless of whether an individual has comorbid Type 2 Diabetes or not. […] In people with severe cardiomyopathy (left ventricular ejection fraction below 35%), or in those with recurrent VT or malignant arrhythmias, treatment with an automatic implantable cardioverter-defibrillator (AICD) is indicated to reduce the risk of severe life-threatening arrhythmias.

• #18 Heart failure – Wikipedia

  https://en.wikipedia.org/wiki/Heart_failure

  Cardiac contractility modulation (CCM) is a treatment for people with moderate to severe left ventricular systolic heart failure (NYHA classes II-III), which enhances both the strength of ventricular contraction and the heart’s pumping capacity. […] People with the most severe heart failure may be candidates for ventricular assist devices, which have commonly been used as a bridge to heart transplantation but have been used more recently as a destination treatment for advanced heart failure. […] In select cases, heart transplantation can be considered.

• #19 Pharmacologic Treatment For HFpEF: Role of Drug Therapies at the Higher End of LVEF Spectrum

  https://www.acc.org/Latest-in-Cardiology/Articles/2022/03/08/18/51/Pharmacologic-Treatment-For-HFpEF

  Pharmacologic Treatment For HFpEF: Role of Drug Therapies at the Higher End of LVEF Spectrum […] The complex pathophysiology of heart failure with preserved ejection fraction (HFpEF) makes it a diagnostic and therapeutic challenge. […] Renin-angiotensin aldosterone system inhibitors and sodium-glucose cotransport-2 inhibitors have emerged as promising drug therapies for reducing heart failure hospitalizations in HFpEF. […] To date, no medication classes have reduced cardiovascular or all-cause mortality in HFpEF. […] Management of HFpEF ranges from lifestyle interventions, (diet, exercise training), management of modifiable risk factors and comorbidities (hypertension, coronary artery disease, atrial fibrillation, obesity, diabetes, cigarette smoking), to pharmacologic therapies, and health services.

• #20 New Insights on HFpEF Treatment | HFpEF

  https://www.cfrjournal.com/articles/therapy-and-management-heart-failure-preserved-ejection-fraction-new-insights-treatment?language_content_entity=en

  Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterised by the presence of diastolic dysfunction and elevated left ventricular filling pressure, in the setting of a left ventricular ejection fraction of at least 50%. […] Recently, the paradigm has changed and the unmet clinical need for HFpEF treatment found a proper response as a result of a new class of drug, the sodiumglucose cotransporter 2 inhibitors (SGLT2i), which beneficially act through the whole spectrum of LVEF. […] In this review, we focus on the HFpEF phenotypes according to the latest evidence, the role of the new drugs and the potential role of new devices to treat this complex syndrome. […] The introduction of SGLT2i has opened up a new avenue for HF treatment beyond neurohormonal activation control.

• #20 New Insights on HFpEF Treatment | HFpEF

  https://www.cfrjournal.com/articles/therapy-and-management-heart-failure-preserved-ejection-fraction-new-insights-treatment?language_content_entity=en

  In summary, empagliflozin and dapagliflozin significantly reduced the incidence of CV events and worsening HF in HFpEF, demonstrating that SGLT2i improved the prognosis of HF patients across the entire LVEF spectrum. […] The introduction of SGLT2i has transformed the paradigm of HFpEF treatment. […] According to new evidence, SGLT2i should be introduced during hospitalisation for acute HF. […] The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines give a class 2b recommendation for MRA use, with the aim of reducing HF hospitalisation, especially in the lower LVEF range. […] Ultimately, the goal of phenotyping is not only to better understand the complex pathophysiological mechanisms underlying HFpEF, but also to provide cardiologists with as many tools as possible to improve the quantity and, above all, the quality of life of their patients.

• #21 GDMT for Heart Failure | CFR Journal

  https://www.cfrjournal.com/articles/initiation-and-titration-guideline-directed-medical-therapy-patients-heart-failure-better?language_content_entity=en

  Treatment for heart failure has experienced a major revolution in recent years, and current evidence shows that a combination of four medications (angiotensin receptor-neprilysin inhibitors + -blockers + mineralocorticoid receptor antagonists + sodium-glucose cotransporter 2 inhibitors) offer the greatest benefit to our patients with significant reductions in cardiovascular mortality, heart failure hospitalisations and all-cause mortality. […] Unfortunately, despite their proven benefits, the implementation of these therapies is still low. Clinical inertia, and unfounded fear of using these drugs might contribute to this. Recently, evidence from randomised clinical trials has shown that intensive implementation of these therapies in patients with heart failure is safe and effective. […] In this review, we aim to summarise the evidence behind the implementation of foundational therapy for HF, to tackle some of the fears and misconceptions that contribute to the lack of implementation of newer therapies and to discuss strategies to offer all patients with HF the best treatment available in a timely manner with a focus on HFrEF.

• #21 GDMT for Heart Failure | CFR Journal

  https://www.cfrjournal.com/articles/initiation-and-titration-guideline-directed-medical-therapy-patients-heart-failure-better?language_content_entity=en

  Although the benefit of GDMT in patients with HF is clear, real-world data show that implementation of these therapies is far from optimal. […] More recently, the EVOLUTION-HF registry showed that there is a significant delay in the initiation of novel therapies (dapagliflozin and sacubitril/valsartan) within the 12 months after a hospitalisation for HF. […] Initiating HF medications in patients before discharge is associated with a higher likelihood of adherence and allows for closer monitoring during the first doses; in addition, multiple trials have shown that starting HF therapies during hospitalisation is safe and associated with better outcomes. […] In light of these data, we could say that the best sequence/strategy of initiation and up-titration of GDMT is the one that best fits our patients’ needs. […] Clinicians should understand that successful implementation of GDMT relies on close follow-up of patients after initiation of treatment to evaluate tolerance, detect and correct adverse effects and to up-titrate medications to maximal doses. For most patients, the initiation of four medications at half-doses with up-titration to full doses in 2 weeks seems reasonable.

• #21 GDMT for Heart Failure | CFR Journal

  https://www.cfrjournal.com/articles/initiation-and-titration-guideline-directed-medical-therapy-patients-heart-failure-better?language_content_entity=en

  Despite these great achievements in the treatment of HF and the consistent benefits seen in large randomised clinical trials, the implementation of GDMT remains suboptimal. […] The CHAMP-HF registry included 3,518 patients with HFrEF and analysed the patterns of GDMT use. […] Overall, 2% of the population had an absolute contraindication to receive ARNI/ACEI/ARB, -blocker or MRA. Of those who were eligible to receive GDMT, 73.4% received ARNI/ACEI/ARB, 67% a -blocker, and only 33.4% received an MRA; of those receiving RAASI, only 13% received an ARNI and the rest ACEI/ARB. Less than 30% of the patients receiving ARNI/ACEI/ARB and a -blocker received target doses, while of those receiving an MRA, 75% were on target dose. Only 1.1% of the patients were on target doses of a combination of three medications.

• #22 Optimizing GDMT for HFrEF During Hospitalization

  https://www.uscjournal.com/articles/optimizing-guideline-directed-medical-therapies-heart-failure-reduced-ejection-fraction?language_content_entity=en

  Heart failure remains a huge societal concern despite medical advancement, with an annual direct cost of over $30 billion. While guideline-directed medical therapy (GDMT) is proven to reduce morbidity and mortality, many eligible patients with heart failure with reduced ejection fraction (HFrEF) are not receiving one or more of the recommended medications, often due to suboptimal initiation and titration in the outpatient setting. Hospitalization serves as a key point to initiate and titrate GDMT. Four evidence-based therapies have clinical benefit within 30 days of initiation and form a crucial foundation for HFrEF therapy: renin-angiotensin-aldosterone system inhibitors with or without a neprilysin inhibitor, -blockers, mineralocorticoid-receptor-antagonists, and sodium-glucose cotransporter-2 inhibitors. The authors present a practical guide for the implementation of these four pillars of GDMT during a hospitalization for acute heart failure.

• #22 Optimizing GDMT for HFrEF During Hospitalization

  https://www.uscjournal.com/articles/optimizing-guideline-directed-medical-therapies-heart-failure-reduced-ejection-fraction?language_content_entity=en

  Guideline-directed medical therapy (GDMT) is proven to reduce mortality and morbidity for patients with HFrEF. GDMT includes the following drug therapies: renin-angiotensin-aldosterone system inhibitors (RAAS-I), with or without a neprilysin inhibitor, -blockers, and mineralocorticoid-receptor-antagonists (MRA). […] Recently, sodium-glucose cotransporter-2 inhibitors (SGLT2i) demonstrated efficacy as an important fourth pillar of GDMT. […] Hospitalization provides an opportunity to initiate and titrate medical therapy with close monitoring in patients with new-onset or acute on chronic HFrEF. […] An acute heart failure (AHF) hospitalization is an important opportunity to initiate and titrate all four pillars of GDMT, laying a complete foundation for further outpatient optimization. […] According to expert consensus, optimization of GDMT in an AHF hospitalization should occur once a positive clinical trajectory has been obtained.

• #23 Non-Pharmacological Therapy in Heart Failure and Management of Heart Failure in Special Populations—A Review

  https://www.mdpi.com/2077-0383/13/22/6993

  Non-pharmacological therapies play an essential role in the management of heart failure, complementing pharmacological treatments to mitigate disease progression and improve patient outcomes. […] A guideline-directed medical therapy (GDMT) has been well studied and established as the mainstay of treatment. Yet, non-pharmacological management of HF is equally as important to mitigate and decrease the complications that arise from HF. […] The four core tenets of non-pharmacological management of HF include (1) adopting a lifestyle where patients follow a low sodium diet, (2) restricting the amount of fluid consumption, (3) weighing themselves daily, and (4) abiding with the recommendations and guidelines set for them by their physicians regarding exercise therapy and activity training. […] Effective lifestyle modifications are an integral component in the management of HF, complementing GDMT by reducing symptom burden and hospitalizations and concomitantly improving quality of life.

• #23 Non-Pharmacological Therapy in Heart Failure and Management of Heart Failure in Special Populations—A Review

  https://www.mdpi.com/2077-0383/13/22/6993

  Physical activity has been linked to increased quality of life, exercise capacity, and decreased hospitalizations. […] Exercise-based cardiac rehabilitation programs have been shown to significantly enhance functional status, as measured by the 6 min walk test and reduce all-cause and HF-related hospitalizations. […] Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) are viable options for helping patients with HF reduce overall mortality and prevent sudden cardiac death (SCD). […] CRT assists with coordinating cardiac contractions in the lower chambers of the heart and has also been found to decrease the incidence of life-threatening arrhythmias like ventricular tachycardia (V-Tach) and ventricular fibrillation. […] In patients diagnosed with NYHA functional classes II–IV secondary to mitral regurgitation, MitraClip implantation lowered 2-year mortality rates or heart failure-related hospitalizations compared with only providing GDMT.

• #24 Advanced Heart Failure Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/advanced-heart-failure/treatment-options

  Through the efforts of the American College of Cardiology Foundation and American Heart Association, there are clearly defined guidelines for the treatment of heart failure at each of its 4 classes: […] In all stages of heart failure, lifestyle changes play a significant role in alleviating symptoms and reducing further damage to the heart. […] When you have advanced heart failure, it’s important for your doctor to know if your condition is worsening, even before you notice symptoms. […] Depending upon the stage and symptoms of your heart failure, your doctor may prescribe medications to help with the following: […] If medications are not effectively managing your heart failure, your doctor may suggest surgery. […] Heart transplantation for eligible patients with end-stage heart failure who cannot be helped by other treatments.

• #25 Heart Failure Treatment: Options for Congestive Heart Failure

  https://www.webmd.com/heart-disease/heart-failure/heart-failure-treatment

  If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing it. […] This device is similar to a pacemaker. It’s put under your skin in your chest. Wires lead through your veins and into your heart to keep track of your heart rhythm. If your heart starts to beat at a dangerous rhythm, or if it stops, the ICD tries to pace your heart or shock it back into normal rhythm. […] Monitor your symptoms. Check for changes in how much fluid builds up in your body by weighing yourself every day. […] If you smoke or chew tobacco, quit. […] Exercise regularly. A regular program that’s OK’d by your doctor will improve your symptoms and strength and make you feel better. It may also slow your heart failure. […] Take your medications as prescribed. Don’t stop taking them without first asking your doctor. Even if you have no symptoms, the drugs help your heart pump better. […] It takes a team to manage heart failure, and you are the key player. Your heart doctor will prescribe your medications and manage other medical problems.

• #26 Reddit – The heart of the internet

  https://www.reddit.com/r/Heartfailure/comments/cfwgua/a_cure_for_heart_failure_my_experience/

  Medical consensus on Heart Failure and Cardiomyopathies is that there is no „cure”, there is only treatment. You can take Medications that will delay the worsening of the disease and ultimately you will need intervention. […] „Heart failure caused by damage to the heart that has developed over time can’t be cured. But it can be treated…” […] „You can’t reverse or cure cardiomyopathy, but you can control it with some of the following options:…” […] „Patients suffering from heart failure, reduced exercise capacity is closely connected to poor prognosis….Previously, exercise training was considered the only way to treat such a reduced exercise capacity.” […] „Exercise training and cardiac rehabilitation have demonstrated numerous benefits for people with CHF, including improved exercise capacity and QoL, in addition to improved clinical outcomes. Exercise has also been established as safe and feasible with HF and, in some studies, exercise therapy has demonstrated improved cost-efficiency in HF management.” […] „Taking the right steps with respect to diet and exercise has the potential to do what is currently considered impossible. I want to see it standard to make diet and exercise changes part of HF treatment.”

• #27 Heart Failure Management | Doctor

  https://patient.info/doctor/heart-failure-management

  Chronic heart failure may be compensated and stable with few signs and baseline symptoms, or decompensated with a recent clinical deterioration and physical evidence of impaired perfusion and oxygenation. […] In cases of decompensation, always consider both the original aetiology of the heart failure and potential causes of any deterioration such as: […] Patient and family education and training in self-care are effective at improving adherence, symptom control, functional capacity and well-being. […] Community-based heart failure nurses provide an important adjunct to self-care, as well as a bridge to secondary care. […] Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure therapies.

• #28 Heart Failure (HF) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/heart-failure-hf

  There are currently several evidence-based therapies for chronic HFrEF. […] There are fewer evidence-based treatments for chronic HFpEF, HFmrEF, acute HF syndromes, and RV failure. […] General measures, especially patient and caregiver education and diet and lifestyle modifications, are important for all patients with heart failure. […] Patient and caregiver education are critical to long-term success. […] Many centers have integrated health care practitioners from different disciplines into multidisciplinary teams or outpatient heart failure management programs. […] Dietary sodium restriction helps limit fluid retention. […] Monitoring daily morning weight helps detect sodium and water accumulation early. […] If causes such as hypertension, persistent tachyarrhythmia, severe anemia, hemochromatosis, uncontrolled diabetes, thyrotoxicosis, beriberi, alcohol use disorder, or toxoplasmosis are successfully treated, patients may dramatically improve.

• #29

  https://www.nhs.uk/conditions/heart-failure/treatment/

  For most people, heart failure is a long-term condition that can’t be cured. But treatment can help keep the symptoms under control, possibly for many years. […] The main treatments are: healthy lifestyle changes, medication, devices implanted in your chest to control your heart rhythm, surgery. […] In many cases, a combination of treatments will be required. […] Treatment will usually need to continue for the rest of your life. […] Most people with heart failure are treated with medication. Often you’ll need to take 2 or 3 different medicines. […] You may need to try a few different medicines before you find a combination that controls your symptoms but doesn’t cause unpleasant side effects. […] Medicines are the main treatment for heart failure, but for some people surgery may help.

• #29

  https://www.nhs.uk/conditions/heart-failure/treatment/

  Operations that can help with heart failure include: heart valve surgery, a coronary angioplasty or bypass, left ventricular assist devices, heart transplant. […] A heart transplant may be necessary if you develop severe heart failure that can’t be treated effectively with medication or other types of surgery.

• #30 Heart Failure Treatment, Strategies, & Insights – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/features/heart-failure-treatment/

  The OPTIMIZER Smart System is an FDA-approved IPG. […] Evidence suggests that at least 3 months of treatment with the OPTIMIZER IPG can lead to improvements in patients functional status, exercise tolerance and overall quality of life. […] The Barostim Neo System is an FDA-approved IPG. […] The CardioMEMS HF System is an implantable medical device that is FDA-approved for monitoring patients with NYHA Class II or III heart failure who have been hospitalized within the past year and/or have elevated natriuretic peptides. […] Ventricular assist devices (VADs) are mechanical devices used to help a weakened heart pump blood more efficiently. […] Researchers continue to improve the technology behind VADs, including significant size reductions, optimized pump efficiency, and enhanced clinical applicability.

• #31 Heart Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/163062-overview

  Treatment includes the following: […] Nonpharmacologic therapy: Oxygen and noninvasive positive pressure ventilation, dietary sodium and fluid restriction, physical activity as appropriate, and attention to weight gain […] Pharmacotherapy: Diuretics, vasodilators, inotropic agents, anticoagulants, beta blockers, ACEIs, ARBs, CCBs, digoxin, nitrates, B-type natriuretic peptides, I(f) inhibitors, ARNIs, soluble guanylate cyclase stimulators, SGLT2Is, and MRAs […] Surgical treatment options include the following: […] Electrophysiologic intervention […] Revascularization procedures […] Valve replacement/repair […] Ventricular restoration […] Extracorporeal membrane oxygenation […] Ventricular assist devices […] Heart transplantation […] Total artificial heart […] See Treatment and Medication for more detail.

• #32 Congestive heart failure life expectancy: Prognosis and stages

  https://www.medicalnewstoday.com/articles/321538

  Other key components of CHF treatment include: Mineralocorticoid receptor blockers (MRAs): Doctors recommend MRAs for people with an EF of 35% or less. MRAs can help improve blood flow and heart function. […] Sodium-glucose co-transporter-2 (SGLT2) inhibitors: SGLT2 inhibitors can assist in glucose control and reduce the risk of heart complications. […] Doctors may also prescribe beta-blockers to support these efforts and control the heart rate. […] In the later stages of heart failure, doctors may recommend surgery to insert a left ventricular assisted device (LVAD) into a person’s heart. An LVAD is a pump that helps the heart muscle contract. It can be a permanent solution for people with heart failure. […] A heart transplant may also be an option if the person is a good candidate for the surgery.

• #33 Refractory Heart Failure: Definition, Symptoms, & Treatment

  https://www.verywellhealth.com/refractory-heart-failure-overview-and-more-5208950

  Cardiac resynchronization therapy (CRT) is recommended for people who meet specific criteria of heart failure and have electrocardiogram (ECG) abnormalities. […] Inotropes are medications that improve the heart’s contractility, including milrinone and dobutamine. […] Mechanical circulatory support refers to the use of implanted devices that assist the heart in pumping blood. […] Heart transplants are performed in some people with refractory heart failure. […] Palliative care is an important part of treating refractory heart failure with the goal of improving quality of life.

• #34 Heart Failure: Treatment by Stage

  https://www.webmd.com/heart-disease/heart-failure/heart-failure-treatment-by-stage

  Stage B: All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitor), angiotensin II receptor blocker (ARB), or angiotensin receptor neprilysin inhibitors (ARNI) like sacubitril/valsartan (Entresto), which is indicated for the treatment of patients with chronic heart failure. […] Stage C: All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitor) and beta-blocker. […] Diuretics (water pills) and digoxin may be prescribed if symptoms persist. […] An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies. […] Stage D: Patient should be evaluated to determine if the following treatments are available options: heart transplant, ventricular assist devices, surgery options, research therapies, continuous infusion of intravenous heart pump drugs, and end-of-life (palliative or hospice) care.

• #35 Advancements in Heart Failure Management: A Comprehensive Narrative Review of Emerging Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10623504/

  Heart failure is a substantial and escalating global health challenge, affecting millions worldwide. Traditionally, the management of Heart failure has focused on alleviating symptoms, reducing fluid retention, and enhancing cardiac contractility. These goals have been achieved through a combination of pharmacological therapies such as angiotensin-converting enzyme inhibitors, beta-blockers, and diuretics, often complemented by device-based interventions like implantable cardioverter-defibrillators and cardiac resynchronization therapy. […] In recent years, researchers and clinicians have embarked on a quest to identify novel therapeutic approaches that address these underlying mechanisms. One such avenue of exploration involves the revolutionary field of gene therapy, with promising gene-editing techniques, such as CRISPR-Cas9, offering potential routes for correcting genetic mutations that contribute to heart failure. Additionally, regenerative medicine approaches, including stem cell therapy and tissue engineering, hold significant promise for repairing damaged cardiac tissue and restoring function.

• #35 Advancements in Heart Failure Management: A Comprehensive Narrative Review of Emerging Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10623504/

  Heart failure therapy has evolved substantially in recent decades, influenced mainly by advancements in research and clinical practices. Pharmacological therapies, such as angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, angiotensin receptor blockers (ARBs), and diuretics, have historically served as the fundamental approach to managing heart failure. […] In addition, implantable devices such as implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) have emerged as crucial instruments in the arsenal against heart failure, demonstrating significant reductions in mortality and hospitalizations among specific groups of patients. […] Cardiac transplantation has consistently been recognized as the preferred treatment for people with end-stage heart failure, offering a vital opportunity for individuals with persistent symptoms and compromised cardiac performance.

• #35 Advancements in Heart Failure Management: A Comprehensive Narrative Review of Emerging Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10623504/

  Emerging therapies comprise a diverse range of innovative methods, including advanced pharmacological agents, interventions based on devices, regenerative medicine efforts, and precision medicine projects. The principal objective of these nascent medicines is to enhance patient outcomes, optimize quality of life, and more efficiently target the underlying processes of heart failure. […] The management of heart failure has evolved significantly over the past few decades, focusing on alleviating symptoms, improving quality of life, reducing hospitalizations, and prolonging survival. Treatment strategies are tailored to the type and stage of heart failure, with a primary division between HFrEF and HFpEF. […] Device-based therapies, such as LVADs and ICDs, carry risks of complications, including infections, bleeding, and device malfunction. Access to advanced treatments such as heart transplantation and LVADs is limited by donor organ availability and cost considerations.

• #35 Advancements in Heart Failure Management: A Comprehensive Narrative Review of Emerging Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10623504/

  Ventricular assist devices (VADs) are mechanical pumps implanted in patients with advanced heart failure as a bridge to transplant or destination therapy. […] Heart failure is a complex and debilitating condition characterized by the inability of the heart to pump blood effectively, leading to symptoms such as fatigue, shortness of breath, and fluid retention. […] In recent years, regenerative medicine and stem cell therapy have emerged as promising approaches to repair damaged cardiac tissue and improve heart function. […] While stem cell therapy holds great promise for heart failure treatment, it is essential to acknowledge the current status of these therapies in clinical practice. […] Despite the challenges, stem cell therapy remains promising for heart failure treatment. […] Emerging therapies in managing heart failure hold substantial promise, with the potential to profoundly impact patient care, clinical decision-making, and the broader landscape of heart failure management.

• #36 Recent successes in heart failure treatment | Nature Medicine

  https://www.nature.com/articles/s41591-023-02567-2

  Remarkable recent advances have revolutionized the field of heart failure. Survival has improved among individuals with heart failure and a reduced ejection fraction and for the first time, new therapies have been shown to improve outcomes across the entire ejection fraction spectrum of heart failure. Great strides have been taken in the treatment of specific cardiomyopathies such as cardiac amyloidosis and hypertrophic cardiomyopathy, whereby conditions once considered incurable can now be effectively managed with novel genetic and molecular approaches. […] Yet there remain substantial residual unmet needs in heart failure. The translation of successful clinical trials to improved patient outcomes is limited by large gaps in implementation of care, widespread lack of disease awareness and poor understanding of the socioeconomic determinants of outcomes and how to address disparities. Ongoing clinical trials, advances in phenotype segmentation for precision medicine and the rise in technology solutions all offer hope for the future.

• #37 Pharmacological and Non-Pharmacological Advancements in Heart Failure Treatment

  https://www.imrpress.com/journal/RCM/25/6/10.31083/j.rcm2506230/htm

  Heart failure (HF) is a complex, life-threatening condition characterized by high mortality, morbidity, and poor quality of life. […] Current research has focused on how HF affects the entire range of left ventricular ejection fraction (LVEF), especially the three HF subgroups. This review provides a latest overview of pharmacological and non-pharmacological strategies of these three subgroups (HF with preserved ejection fraction, HF with reduced ejection fraction, and HF with mildly reduced ejection fraction). […] Therefore, developing new, preventative, and reparative treatment strategies is necessary. HF is classified into three subtypes based on left ventricular ejection fraction (LVEF): heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%), heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%), and heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 41–49%). This review provides an overview of the recent pharmacological and non-pharmacological treatments for patients with the three HF subtypes.

• #37 Pharmacological and Non-Pharmacological Advancements in Heart Failure Treatment

  https://www.imrpress.com/journal/RCM/25/6/10.31083/j.rcm2506230/htm

  The use of epigenetic-based therapy, also known as “epidrugs”, is gaining interest among the medical community. […] Therefore, these studies demonstrate that HFpEF is linked to dysfunction of the mitochondria in the myocardium and suggest that replenishing NAD+ levels is a promising therapeutic strategy for this condition. […] Another effective method for treatment of HFpEF is to focus on long-term inflammation, which results in oxidative stress and microvascular dysfunction, which are significant factors in HFpEF. […] Therefore, it is a potential target for the therapeutic intervention of HFpEF against MPO. […] Therefore, treatment with metformin is related to a reduction in mortality for patients with HFpEF. […] The objectives of cardiac rehabilitation in patients with HFpEF generally consist of enhancing exercise capacity, optimizing medication therapy, and promoting a healthy lifestyle. […] Therefore, it is crucial to encourage the prescription of exercise training programs for HFpEF patients.

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