Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care
Abstract Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality of life and a major burden for the healthcare system. The number of patients that progress to an advanced stage of HF is growing. Only a limited proportion of these patients can undergo heart transplanta...
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13859 |
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| author | Daniela Tomasoni Julie K.K. Vishram‐Nielsen Matteo Pagnesi Marianna Adamo Carlo Mario Lombardi Finn Gustafsson Marco Metra |
| author_facet | Daniela Tomasoni Julie K.K. Vishram‐Nielsen Matteo Pagnesi Marianna Adamo Carlo Mario Lombardi Finn Gustafsson Marco Metra |
| author_sort | Daniela Tomasoni |
| collection | DOAJ |
| description | Abstract Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality of life and a major burden for the healthcare system. The number of patients that progress to an advanced stage of HF is growing. Only a limited proportion of these patients can undergo heart transplantation or mechanical circulatory support. The purpose of this review is to summarize medical management of patients with advanced HF. First, evidence‐based oral treatment must be implemented although it is often not tolerated. New therapeutic options may soon become possible for these patients. The second goal is to lessen the symptomatic burden through both decongestion and haemodynamic improvement. Some new treatments acting on cardiac function may fulfil both these needs. Inotropic agents acting through an increase in intracellular calcium have often increased risk of death. However, in the recent Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial, omecamtiv mecarbil was safe and effective in the reduction of the primary outcome of cardiovascular death or HF event compared with placebo (hazard ratio, 0.92; 95% confidence interval, 0.86–0.99; P = 0.03) and its effects were larger in those patients with more severe left ventricular dysfunction. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit, whereas patients without severe HF did not (P = 0.005 for interaction). Lastly, clinicians should take care of the end of life with an appropriate multidisciplinary approach. Medical treatment of advanced HF therefore remains a major challenge and a wide open area for further research. |
| format | Article |
| id | doaj-art-207c4ed3634e4075b6feb207339b0b7a |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-207c4ed3634e4075b6feb207339b0b7a2025-02-05T05:22:09ZengWileyESC Heart Failure2055-58222022-06-01931507152310.1002/ehf2.13859Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative careDaniela Tomasoni0Julie K.K. Vishram‐Nielsen1Matteo Pagnesi2Marianna Adamo3Carlo Mario Lombardi4Finn Gustafsson5Marco Metra6Cardiology, Cardio‐thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia ItalyDepartment of Cardiology Rigshospitalet, University of Copenhagen Copenhagen DenmarkCardiology, Cardio‐thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia ItalyCardiology, Cardio‐thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia ItalyCardiology, Cardio‐thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia ItalyDepartment of Cardiology Rigshospitalet, University of Copenhagen Copenhagen DenmarkCardiology, Cardio‐thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia ItalyAbstract Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality of life and a major burden for the healthcare system. The number of patients that progress to an advanced stage of HF is growing. Only a limited proportion of these patients can undergo heart transplantation or mechanical circulatory support. The purpose of this review is to summarize medical management of patients with advanced HF. First, evidence‐based oral treatment must be implemented although it is often not tolerated. New therapeutic options may soon become possible for these patients. The second goal is to lessen the symptomatic burden through both decongestion and haemodynamic improvement. Some new treatments acting on cardiac function may fulfil both these needs. Inotropic agents acting through an increase in intracellular calcium have often increased risk of death. However, in the recent Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial, omecamtiv mecarbil was safe and effective in the reduction of the primary outcome of cardiovascular death or HF event compared with placebo (hazard ratio, 0.92; 95% confidence interval, 0.86–0.99; P = 0.03) and its effects were larger in those patients with more severe left ventricular dysfunction. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit, whereas patients without severe HF did not (P = 0.005 for interaction). Lastly, clinicians should take care of the end of life with an appropriate multidisciplinary approach. Medical treatment of advanced HF therefore remains a major challenge and a wide open area for further research.https://doi.org/10.1002/ehf2.13859Advanced heart failureHeart failure with reduced ejection fractionMedical managementDiuretic therapyInotropesOmecamtiv mecarbil |
| spellingShingle | Daniela Tomasoni Julie K.K. Vishram‐Nielsen Matteo Pagnesi Marianna Adamo Carlo Mario Lombardi Finn Gustafsson Marco Metra Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care ESC Heart Failure Advanced heart failure Heart failure with reduced ejection fraction Medical management Diuretic therapy Inotropes Omecamtiv mecarbil |
| title | Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care |
| title_full | Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care |
| title_fullStr | Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care |
| title_full_unstemmed | Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care |
| title_short | Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care |
| title_sort | advanced heart failure guideline directed medical therapy diuretics inotropes and palliative care |
| topic | Advanced heart failure Heart failure with reduced ejection fraction Medical management Diuretic therapy Inotropes Omecamtiv mecarbil |
| url | https://doi.org/10.1002/ehf2.13859 |
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