Dalal Jamshed, Chandra Praveen, Ray Saumitra, Hazra P K, Hiremath Jagdish, Kumar Viveka, Shah Mahesh K, Abdullakutty Jabir, Ghosh Debasis, Vasudevan Karthik, Sahoo Panchanan
Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
Medanta Hospital, Gurugram, India.
Cardiol Ther. 2023 Sep;12(3):445-471. doi: 10.1007/s40119-023-00323-8. Epub 2023 Jun 29.
Heart failure is a significant public health concern characterized by notable rates of morbidity and mortality. Despite the presence of guideline-directed medical therapy (GDMT), its utilization remains inadequate. This practical recommendation paper focuses on the utilization of angiotensin receptor-neprilysin inhibitor (ARNI) as a pivotal treatment for heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and heart failure with improved ejection fraction (HFimpEF). The recommendations presented in this paper have been developed by a group of cardiologists in India who convened six advisory board meetings to discuss the utilization of ARNI in the management of heart failure. The paper emphasizes the importance of accurate biomarkers for diagnosing heart failure, particularly N-terminal pro-B-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP), which are commonly used. Additionally, the paper advocates the use of imaging, specifically echocardiography, in diagnosing and monitoring heart failure patients. Moreover, the paper highlights the role of ARNI in heart failure management, with numerous clinical trials that have demonstrated its effectiveness in reducing cardiovascular death or heart failure hospitalization, enhancing quality of life, and diminishing the risk of ventricular arrhythmias. This practical recommendation paper offers valuable insights into the utilization of ARNI in the management of heart failure, aiming to enhance the implementation of GDMT and ultimately alleviate the burden of heart failure on society.
心力衰竭是一个重大的公共卫生问题,其发病率和死亡率都很高。尽管有指南指导的药物治疗(GDMT),但其应用仍然不足。本实用推荐文件重点关注血管紧张素受体脑啡肽酶抑制剂(ARNI)在射血分数降低的心力衰竭(HFrEF)、射血分数保留的心力衰竭(HFpEF)和射血分数改善的心力衰竭(HFimpEF)治疗中的关键作用。本文提出的建议由一组印度心脏病专家制定,他们召开了六次咨询委员会会议,讨论ARNI在心力衰竭管理中的应用。该文件强调了准确的生物标志物对诊断心力衰竭的重要性,特别是常用的N末端B型利钠肽原(NT-proBNP)和B型利钠肽(BNP)。此外,该文件提倡使用影像学检查,特别是超声心动图,来诊断和监测心力衰竭患者。此外,该文件强调了ARNI在心力衰竭管理中的作用,众多临床试验已证明其在降低心血管死亡或心力衰竭住院率、提高生活质量以及降低室性心律失常风险方面的有效性。本实用推荐文件为ARNI在心力衰竭管理中的应用提供了有价值的见解,旨在加强GDMT的实施,并最终减轻心力衰竭对社会的负担。