Advanced heart failure: guideline-directed medical therapy, diuretics, inotropes, and palliative care
Research output: Contribution to journal › Review › Research › peer-review
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Advanced heart failure : guideline-directed medical therapy, diuretics, inotropes, and palliative care. / Tomasoni, Daniela; Vishram-Nielsen, Julie K. K.; Pagnesi, Matteo; Adamo, Marianna; Lombardi, Carlo Mario; Gustafsson, Finn; Metra, Marco.
In: ESC heart failure, Vol. 9, No. 3, 2022, p. 1507-1523.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Advanced heart failure
T2 - guideline-directed medical therapy, diuretics, inotropes, and palliative care
AU - Tomasoni, Daniela
AU - Vishram-Nielsen, Julie K. K.
AU - Pagnesi, Matteo
AU - Adamo, Marianna
AU - Lombardi, Carlo Mario
AU - Gustafsson, Finn
AU - Metra, Marco
PY - 2022
Y1 - 2022
N2 - Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality of life and a major burden for the healthcare system. The number of patients that progress to an advanced stage of HF is growing. Only a limited proportion of these patients can undergo heart transplantation or mechanical circulatory support. The purpose of this review is to summarize medical management of patients with advanced HF. First, evidence-based oral treatment must be implemented although it is often not tolerated. New therapeutic options may soon become possible for these patients. The second goal is to lessen the symptomatic burden through both decongestion and haemodynamic improvement. Some new treatments acting on cardiac function may fulfil both these needs. Inotropic agents acting through an increase in intracellular calcium have often increased risk of death. However, in the recent Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial, omecamtiv mecarbil was safe and effective in the reduction of the primary outcome of cardiovascular death or HF event compared with placebo (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99; P = 0.03) and its effects were larger in those patients with more severe left ventricular dysfunction. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit, whereas patients without severe HF did not (P = 0.005 for interaction). Lastly, clinicians should take care of the end of life with an appropriate multidisciplinary approach. Medical treatment of advanced HF therefore remains a major challenge and a wide open area for further research.
AB - Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality of life and a major burden for the healthcare system. The number of patients that progress to an advanced stage of HF is growing. Only a limited proportion of these patients can undergo heart transplantation or mechanical circulatory support. The purpose of this review is to summarize medical management of patients with advanced HF. First, evidence-based oral treatment must be implemented although it is often not tolerated. New therapeutic options may soon become possible for these patients. The second goal is to lessen the symptomatic burden through both decongestion and haemodynamic improvement. Some new treatments acting on cardiac function may fulfil both these needs. Inotropic agents acting through an increase in intracellular calcium have often increased risk of death. However, in the recent Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial, omecamtiv mecarbil was safe and effective in the reduction of the primary outcome of cardiovascular death or HF event compared with placebo (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99; P = 0.03) and its effects were larger in those patients with more severe left ventricular dysfunction. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit, whereas patients without severe HF did not (P = 0.005 for interaction). Lastly, clinicians should take care of the end of life with an appropriate multidisciplinary approach. Medical treatment of advanced HF therefore remains a major challenge and a wide open area for further research.
KW - Advanced heart failure
KW - Heart failure with reduced ejection fraction
KW - Medical management
KW - Diuretic therapy
KW - Inotropes
KW - Omecamtiv mecarbil
KW - Palliative care
KW - REDUCED EJECTION FRACTION
KW - PULMONARY-ARTERY PRESSURE
KW - CARDIAC MYOSIN ACTIVATOR
KW - OMECAMTIV MECARBIL
KW - DOUBLE-BLIND
KW - INCREASE CONTRACTILITY
KW - AMERICAN-COLLEGE
KW - EUROPEAN-SOCIETY
KW - LEVOSIMENDAN
KW - MORTALITY
U2 - 10.1002/ehf2.13859
DO - 10.1002/ehf2.13859
M3 - Review
C2 - 35352499
VL - 9
SP - 1507
EP - 1523
JO - E S C Heart Failure
JF - E S C Heart Failure
SN - 2055-5822
IS - 3
ER -
ID: 308114670