Heart Failure Pharmacological Management: Gaps and Current Perspectives

Severino, Paolo; D'Amato, Andrea; Prosperi, Silvia; Myftari, Vincenzo; Canuti, Elena Sofia; Labbro Francia, Aurora; Cestiè, Claudia; Maestrini, Viviana; Lavalle, Carlo; Badagliacca, Roberto; Mancone, Massimo; Vizza, Carmine Dario; Fedele, Francesco

doi:10.3390/jcm12031020

Open AccessPerspective

Heart Failure Pharmacological Management: Gaps and Current Perspectives

by

Paolo Severino

^*,†

,

Andrea D'Amato

^†,

Silvia Prosperi

,

Vincenzo Myftari

,

Elena Sofia Canuti

,

Aurora Labbro Francia

,

Claudia Cestiè

,

Viviana Maestrini

,

Carlo Lavalle

,

Roberto Badagliacca

,

Massimo Mancone

,

Carmine Dario Vizza

and

Francesco Fedele

Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2023, 12(3), 1020; https://doi.org/10.3390/jcm12031020

Submission received: 15 December 2022 / Revised: 7 January 2023 / Accepted: 24 January 2023 / Published: 28 January 2023

(This article belongs to the Special Issue Chronic Heart Failure: Diagnosis and Management beyond LVEF Classification)

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Abstract

Proper therapeutic management of patients with heart failure (HF) is a major challenge for cardiologists. Current guidelines indicate to start therapy with angiotensin converting enzyme inhibitors/angiotensin receptor neprilysin inhibitors (ACEi/ARNI), beta blockers (BB), mineralocorticoid receptor antagonists (MRAs) and sodium glucose cotransporter 2 inhibitors (SGLT2i) to reduce the risk of death and hospitalization due to HF. However, certain aspects still need to be defined. Current guidelines propose therapeutic algorithms based on left ventricular ejection fraction values and clinical presentations. However, these last do not always reflect the precise hemodynamic status of patients and pathophysiological mechanisms involved, particularly in the acute setting. Even in the field of chronic management there are still some critical points to discuss. The guidelines do not specify which of the four pillar drugs to start first, nor at what dosage. Some authors suggest starting with SGLT2i and BB, others with ACEi or ARNI, while one of the most recent approach proposes to start with all four drugs together at low doses. The aim of this review is to revise current gaps and perspectives regarding pharmacological therapy management in HF patients, in both the acute and chronic phase.

Keywords: heart failure; acute heart failure; chronic heart failure; left ventricular ejection fraction; management; therapy

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MDPI and ACS Style

Severino, P.; D'Amato, A.; Prosperi, S.; Myftari, V.; Canuti, E.S.; Labbro Francia, A.; Cestiè, C.; Maestrini, V.; Lavalle, C.; Badagliacca, R.; et al. Heart Failure Pharmacological Management: Gaps and Current Perspectives. J. Clin. Med. 2023, 12, 1020. https://doi.org/10.3390/jcm12031020

AMA Style

Severino P, D'Amato A, Prosperi S, Myftari V, Canuti ES, Labbro Francia A, Cestiè C, Maestrini V, Lavalle C, Badagliacca R, et al. Heart Failure Pharmacological Management: Gaps and Current Perspectives. Journal of Clinical Medicine. 2023; 12(3):1020. https://doi.org/10.3390/jcm12031020

Chicago/Turabian Style

Severino, Paolo, Andrea D'Amato, Silvia Prosperi, Vincenzo Myftari, Elena Sofia Canuti, Aurora Labbro Francia, Claudia Cestiè, Viviana Maestrini, Carlo Lavalle, Roberto Badagliacca, and et al. 2023. "Heart Failure Pharmacological Management: Gaps and Current Perspectives" Journal of Clinical Medicine 12, no. 3: 1020. https://doi.org/10.3390/jcm12031020

APA Style

Severino, P., D'Amato, A., Prosperi, S., Myftari, V., Canuti, E. S., Labbro Francia, A., Cestiè, C., Maestrini, V., Lavalle, C., Badagliacca, R., Mancone, M., Vizza, C. D., & Fedele, F. (2023). Heart Failure Pharmacological Management: Gaps and Current Perspectives. Journal of Clinical Medicine, 12(3), 1020. https://doi.org/10.3390/jcm12031020

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Heart Failure Pharmacological Management: Gaps and Current Perspectives

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