Nowe zalecenia Europejskiego Towarzystwa Kardiologicznego 2021 dotyczące leczenia niewydolności serca z zredukowaną frakcją wyrzutową lewej komory – ewolucja czy rewolucja?

Heart failure (HF) is a chronic, progressive disease with periods of decompensation and remission leading to disability and, in many cases, social exclusion of patients. The number of cases of HF is constantly growing, making it a real epidemic of the 21st century. HF is the most common direct cause of death from cardiovascular causes. The costs of treating patients with HF are high. Furthermore, there are also costs resulting from sickness absence in the workplace of patients with HF borne by all taxpayers. Mortality in patients with HF is high and reaches 40% within 5 years of diagnosis. The recommendations of the European Society of Cardiology published in August 2021 revolutionized the treatment of patients with HF with reduced left ventricular ejection fraction (HFrEF). Currently, it is recommended to initiate as soon as possible full therapy consisting of: angiotensin converting enzyme (ACE-I) inhibitor or angiotensin receptor antagonists and neprilysin inhibitors (ARNI) in combination with a beta-blocker, mineralocorticoid receptor antagonist (ARB) and an inhibitor of the sodium-glucose co-transporter 2 (SGLT2i). These drugs reduce mortality, improve survival, reduce the risk of HF hospitalization, and improve symptoms of HFrEF. These drugs are recommended for all patients with HFrEF. Other drugs used in the treatment of patients with HF are used depending on the individual needs of patients in accordance with the phenotyping principle. Summarizing, the new guidelines simplify the therapeutic scheme of HFrEF indicating the basic treatment recommended for all patients (ACE-I / ARNI + BB + MRA + SGLT2i). However, they leave the possibility of further individualization of the therapy depending on the patient's needs.