Nguyen Andrew H, Hurwitz Madelyn, Abraham Jacob, Blumer Vanessa, Flanagan M Casey, Garan A Reshad, Kanwar Manreet, Kataria Rachna, Kennedy Jamie L W, Kochar Ajar, Hernandez-Montfort Jaime, Pahuja Mohit, Shah Palak, Sherwood Matthew W, Tehrani Behnam N, Vallabhajosyula Saraschandra, Kapur Navin K, Sinha Shashank S
Inova Schar Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia.
School of Medicine, University of Virginia, Charlottesville, Virginia.
J Soc Cardiovasc Angiogr Interv. 2023 Dec 4;2(6Part B):101206. doi: 10.1016/j.jscai.2023.101206. eCollection 2023 Nov-Dec.
Heart failure (HF) remains a major cause of morbidity and mortality worldwide. Major advancements in optimal guideline-directed medical therapy, including novel pharmacological agents, are now available for the treatment of chronic HF including HF with reduced ejection fraction and HF with preserved ejection fraction. Despite these efforts, there are several limitations of medical therapy including but not limited to: delays in implementation and/or initiation; inability to achieve target dosing; tolerability; adherence; and recurrent and chronic costs of care. A significant proportion of patients remain symptomatic with poor HF-related outcomes including rehospitalization, progression of disease, and mortality. Driven by these unmet clinical needs, there has been a significant growth of innovative device-based interventions across all HF phenotypes over the past several decades. This state-of-the-art review will summarize the current landscape of guideline-directed medical therapy for chronic HF, discuss its limitations including barriers to implementation, and review device-based therapies which have established efficacy or demonstrated promise in the management of chronic HF.
心力衰竭（HF）仍是全球发病和死亡的主要原因。目前，在优化的指南指导药物治疗方面取得了重大进展，包括新型药物制剂，可用于治疗慢性HF，包括射血分数降低的HF和射血分数保留的HF。尽管做出了这些努力，但药物治疗仍存在一些局限性，包括但不限于：实施和/或启动延迟；无法达到目标剂量；耐受性；依从性；以及护理的反复和长期成本。相当一部分患者仍有症状，HF相关结局较差，包括再次住院、疾病进展和死亡。在这些未满足的临床需求的推动下，在过去几十年中，针对所有HF表型的基于创新设备的干预措施显著增加。这篇前沿综述将总结慢性HF的指南指导药物治疗的现状，讨论其局限性，包括实施障碍，并综述在慢性HF管理中已确立疗效或显示出前景的基于设备的治疗方法。
