Iacoviello Massimo, Maria Sarullo Filippo, Bilato Claudio, Correale Michele, Di Gesaro Gabriele, Driussi Mauro, Passantino Andrea, Villani Alessandra, Di Lenarda Andrea
Department of Medical and Surgical Sciences, University of Foggia Foggia, Italy.
Cardiac and Cardiovascular Rehabilitation Unit -Buccheri La Ferla Fatebenefratelli Hospital Palermo, Italy.
Card Fail Rev. 2025 Jul 17;11:e16. doi: 10.15420/cfr.2024.39. eCollection 2025.
The high risk of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF) demands urgent efforts in the initiation of guideline-directed medical therapy to reduce morbidity and mortality. Angiotensin receptor-neprilysin inhibitor showed substantial benefits in reducing the risks of heart failure hospitalisation and cardiovascular mortality in HFrEF patients. Therefore, the European Society of Cardiology 2021 guidelines recommend angiotensin receptor-neprilysin inhibitor as a first-line therapy for HFrEF patients. The guidelines emphasise the importance of the early use and rapid titration of the 'four pillars' in HFrEF: angiotensin receptor-neprilysin inhibitor, β-blockers, sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists. However, real-world application of the guidelines remains suboptimal, limiting patient outcomes. This statement paper investigates the barriers to the use of the 'four pillars', and aims to give guidance to improve their implementation in different HFrEF patient types.
射血分数降低的心力衰竭（HFrEF）患者出现不良结局的风险很高，因此迫切需要努力启动指南指导的药物治疗，以降低发病率和死亡率。血管紧张素受体脑啡肽酶抑制剂在降低HFrEF患者心力衰竭住院风险和心血管死亡率方面显示出显著益处。因此，欧洲心脏病学会2021年指南推荐血管紧张素受体脑啡肽酶抑制剂作为HFrEF患者的一线治疗药物。该指南强调了在HFrEF中早期使用和快速滴定“四大支柱”药物的重要性，即血管紧张素受体脑啡肽酶抑制剂、β受体阻滞剂、钠-葡萄糖协同转运蛋白2抑制剂和盐皮质激素受体拮抗剂。然而，该指南在现实世界中的应用仍未达到最佳效果，限制了患者的治疗结局。本声明文件调查了使用“四大支柱”药物的障碍，并旨在为改善其在不同类型HFrEF患者中的应用提供指导。
