The Treatment of Heart Failure with Reduced Ejection Fraction

Berliner, Dominik; Hänselmann, Anja; Bauersachs, Johann

doi:10.3238/arztebl.2020.0376

Cited by 40 publications

(42 citation statements)

References 65 publications

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“…Heart failure with reduced ejection fraction (HFrEF) requires a multimodal treatment with combination of several drugs as the cornerstone for symptomatic and prognostic improvement in all patients. 1 , 2 Drug therapies such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor/neprilysin inhibitors (ARNIs; sacubitril/valsartan), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) provide incremental benefit with marked reduction in all-cause mortality, cardiovascular mortality, all-cause hospitalizations, and hospitalizations for heart failure. 3 Recently, the sodium–glucose co-transporter 2 (SGLT2) inhibitors dapagliflozin (DAPA-HF) and empagliflozin (EMPEROR-Reduced) showed a highly significant and clinically relevant reduction in mortality and heart failure hospitalizations, and improvement of quality of life when added to current standard drugs in patients with HFrEF.…”

mentioning

confidence: 99%

Heart failure drug treatment: the fantastic four

Bauersachs

2021

European Heart Journal

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172

118

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mentioning

confidence: 99%

Heart failure drug treatment: the fantastic four

Bauersachs

2021

European Heart Journal

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172

118

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“…Though CHF is a common condition, if untreated, it will markedly impair QOL; it is associated with a high risk of recurrent hospitalization and death[ 18 ]. Availability of evidence-based treatment options is limited to congestive HF with low EF; the medication has been approved in the United Stated by the Food and Drug Administration (FDA) for the treatment of chronic HFrEF patients of NYHA class II, III, or IV[ 18 , 19 ]. Alongside the past decade’s marked progress in device therapy, more recent advances in CHF management have led to exciting new pharmacological options[ 20 ].…”

Section: Hfmentioning

confidence: 99%

Angiotensin receptor blocker neprilysin inhibitors

Usuda

Higashikawa

Hotchi

et al. 2021

WJC

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Heart failure (HF) is a clinical syndrome that results from a structural or functional cardiac disorder that reduces the ability of the ventricle of the heart to fill with, or eject, blood. It is a multifaceted clinical condition that affects up to 2% of the population in the developed world, and is linked to significant morbidity and mortality; it is therefore considered a major concern for public health. Regarding the mechanism of HF, three neurohumoral factors - the renin-angiotensin-aldosterone system, the sympathetic nervous system, and natriuretic peptides — are related to the pathology of chronic HF (CHF), and the targets of treatment. Angiotensin receptor blocker and neprilysin inhibitor (angiotensin-receptor neprilysin inhibitor), namely sacubitril/valsartan (SAC/VAL), has been introduced as a treatment for CHF. SAC/VAL is an efficacious, safe, and cost-effective therapy that improves quality of life and longevity in patients with HF with reduced ejection fraction (HFrEF), and reduces hospital admissions. An in-hospital initiation strategy offers a potential new avenue to improve the clinical uptake of SAC/VAL. In the last five years, SAC/VAL has been established as a cornerstone component of comprehensive disease-modifying medical therapy in the management of chronic HFrEF. On the other hand, further work, with carefully designed and controlled preclinical studies, is necessary for understanding the molecular mechanisms, effects, and confirmation of issues such as long-term safety in both human and animal models.

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“…Several large randomized placebo-controlled clinical trials provided the basis for MR antagonists (MRAs) as an essential treatment in patients with HF with reduced ejection fraction (HFrEF) and for their class I recommendation in current HF treatment guidelines (Ponikowski et al, 2016;Berliner et al, 2020;Bozkurt et al, 2021).…”

Section: Hf With Reduced Ejection Fractionmentioning

confidence: 99%

Mineralocorticoid receptor in cardiovascular diseases -- clinical trials and mechanistic insights

Bauersachs

Andrés²

2021

Preprint

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Aldosterone binds to the mineralocorticoid receptor (MR), a transcription factor of the nuclear receptor family, present in the kidney and in various other non-epithelial cells including the heart and the vasculature (Cannavo et al., 2018). Indeed, extra-renal pathophysiological effects of this hormone have been characterized, extending its actions to the cardiovascular (CV) system (Messaoudi et al., 2012). A growing body of clinical and pre-clinical evidence suggests that MR activation plays an important pathophysiological role in CV remodeling by promoting cardiac hypertrophy, fibrosis, arterial stiffness, as well as in inflammation and oxidative stress (Bauersachs et al., 2015). The following review article outlines the role of MR in CV disease with a focus on myocardial remodeling and heart failure (HF) including clinical trials as well as cellular and animal studies.

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The Treatment of Heart Failure with Reduced Ejection Fraction

Cited by 40 publications

References 65 publications

Heart failure drug treatment: the fantastic four

Heart failure drug treatment: the fantastic four

Angiotensin receptor blocker neprilysin inhibitors

Mineralocorticoid receptor in cardiovascular diseases -- clinical trials and mechanistic insights

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