Medical Therapy of Heart Failure

Diuretics are first line drugs to improve symptoms of heart failure patients; however they do not increase their long term survival. Administration of medications blocking the neurohormonal activation, such as angiotensin converting enzyme(ACE) inhibitors (alternatively, angiotensin II receptor blockers in patients with intolerance to ACE inhibitors), mineralocorticoid receptor antagonists and beta blockers, lead to long term improvement of both symptoms and prognosis of chronic heart failure patients with reduced ejection fraction (EF<40%). Digoxin and ivabradine are also therapeutic options for heart failure patients in specific clinical scenarios. LCZ 696 is the new promising medication that improves more effectively cardiovascular outcomes in chronic heart failure cases in comparison to ACE inhibitors. In contrast, there are no available life prolonging medications for patients with preserved ejection fraction (EF>50%), and treatment remains empirical targeting only to symptomatic improvement. Treatment of comorbidities, including renal dysfunction, anemia and depression, may improve the well-being and quality of life in chronic heart failure patients, although evidence-based data are still limited.

Keywords: Angiotensin converting enzyme inhibitors, Angiotensin II receptor blockers, Beta blockers, Digoxin, Diuretics, Heart failure, Hydralazine, Isosorbide dinitrate, Ivabradine, Mineralocorticoid receptor antagonists.