Introduction of Pharmacological Treatment Of Patients With Chronic Systolic Heart Failure

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Summary

Chronic heart failure is the leading cause of hospitalisation in Germany¹ and other European countries. It is the result of various cardiovascular diseases, such as myocardial infarction, arterial hypertension and valvular heart diseases. About 50 % of patients with heart failure have normal systolic, but impaired diastolic function, a condition termed heart failure with preserved ejection fraction (HFpEF), in contrast to heart failure with reduced ejection fraction (HFrEF).^2,3 Patients with ischaemic heart disease and/or myocardial infarction are more likely to develop HFrEF, while HFpEF more likely inflicts the elderly, female gender and patients with arterial hypertension.4 While initially it seemed that patients with HFpEF only had a slightly better prognosis than patients with HFrEF (by 4 %),³ more recent evidence suggests that prognosis of HFpEF per se is clearly less adverse than of HFrEF (by 32 %), while frequent co-morbidities affect overall prognosis of patients with HFpEF.^4,5 Over the past decades, advancements in the treatment of patients with HFrEF led to continuous improvements of overall prognosis, while in HFpEF, most drugs used in patients with HFrEF were not effective.^3,6 In the 2012 European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure, definite recommendations for the pharmacological treatment of patients with HFrEF are provided, while recommendations for patients with HFpEF are scarce.⁶ Hence, we herein will focus on the pharmacological treatment of patients with HFrEF and for simplicity will refer to them as patients with ‘heart failure’ (HF).