1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland.
Heart Sector, Hygeia Hospitals Groups, Athens, Greece.
Kardiol Pol. 2023;81(9):850-858. doi: 10.33963/v.kp.97062.
According to the 2021 European Society of Cardiology guidelines, the four pillars of medical therapy in heart failure with reduced ejection fraction (HFrEF) include sodium-glucose co-transporter-2 inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and angiotensin-converting enzyme inhibitors or angiotensin receptor-neprilysin inhibitors. However, in clinical practice, concomitant use of all four drug groups in target doses is often limited by their intolerance or fear of potential complications. Herein, we present strategies to initiate or modify HFrEF therapy in frequent but challenging clinical scenarios (symptomatic hypotension, atrial fibrillation, kidney disease or worsening renal function, hyperkalemia) in a way that does not lead to unnecessary reduction or cessation of life-saving treatment.
根据 2021 年欧洲心脏病学会指南，射血分数降低的心力衰竭（HFrEF）的医学治疗的四大支柱包括钠-葡萄糖共转运蛋白 2 抑制剂、β 受体阻滞剂、盐皮质激素受体拮抗剂以及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。然而，在临床实践中，由于不耐受或担心潜在并发症，常无法将所有四种药物组以目标剂量联合使用。在此，我们提出了在常见但具有挑战性的临床情况下（症状性低血压、心房颤动、肾脏疾病或肾功能恶化、高钾血症）开始或调整 HFrEF 治疗的策略，这些策略不会导致不必要的降低或停止挽救生命的治疗。
