Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
University of Warwick, Coventry, UK.
ESC Heart Fail. 2021 Dec;8(6):4370-4393. doi: 10.1002/ehf2.13760. Epub 2021 Dec 16.
Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin-converting enzyme inhibitors or an angiotensin receptor-neprilysin inhibitor, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM-AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo-controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer-related HF, also occurred. Coronavirus disease 2019 (COVID-19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.
在过去的几年中，心力衰竭（HF）管理发生了重大变化。标志性试验和 2021 年欧洲心脏病学会（ESC）HF 诊断和治疗指南确定了四类用于治疗射血分数降低的 HF 的药物：血管紧张素转换酶抑制剂或血管紧张素受体-脑啡肽酶抑制剂、β受体阻滞剂、盐皮质激素受体拮抗剂和钠-葡萄糖共转运蛋白 2 抑制剂，即达格列净或恩格列净。这些药物一致显示出对死亡率、HF 住院和生活质量的有益作用。纠正铁缺乏症可改善症状并减少 HF 住院。AFFIRM-AHF 研究表明，与安慰剂相比，铁羧基麦芽糖铁可使急性 HF 住院患者的总 HF 住院率降低 26%（P = 0.013）。鸟苷酸环化酶激动剂维立西呱和肌球蛋白激活剂奥马卡汀美卡比在随机安慰剂对照试验中改善了结局，维立西呱现已获准用于临床实践。射血分数保留型心力衰竭（HFpEF）的治疗一直是一个重大的临床未满足需求，直到今年 EMPEROR-Preserved（恩格列净在慢性 HFpEF 患者中的结局试验）的结果公布。与安慰剂相比，恩格列净降低了 21%（风险比，0.79；95%置信区间，0.69 至 0.90；P < 0.001）的主要终点，即心血管死亡或 HF 住院。HF 特定表型的治疗进展，包括心房颤动、心脏瓣膜病、心肌病、心脏淀粉样变性和癌症相关 HF，也取得了进展。2019 年冠状病毒病（COVID-19）大流行仍然在 HF 流行病学和管理中发挥着重要作用。本综述重点介绍了所有这些方面。
