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Otimização do tratamento da insuficiência cardíaca com fração de ejeção reduzida com fármacos modificadores de prognóstico
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Orientador(es)
Resumo(s)
Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients’ functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members’ clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.
Descrição
Funding Information: Medical writer Duarte Oliveira (W4Research) collaborated in the preparation of this article, with financial support from Novartis Portugal. This article contains the authors? opinion on the scientific contents addressed, which are expressed independently of Novartis. Novartis did not participate in the design, discussion of, or writing of this paper. Funding Information: Medical writer Duarte Oliveira (W4Research) collaborated in the preparation of this article, with financial support from Novartis Portugal. This article contains the authors’ opinion on the scientific contents addressed, which are expressed independently of Novartis. Novartis did not participate in the design, discussion of, or writing of this paper. Funding Information: J.S.C. has consulted and received speaker fees, or advisory board participation fees or investigational grants from Abbott, AstraZeneca Pharmaceuticals, Bial, Boehringer Ingelheim, Menarini, Merck Serono, Merck Sharp & Dohme, Novartis, Orion, Pfizer, Sanofi, Servier and Vifor Pharma. C.F. has received speaker and consultancy fees, advisory board participation fees, or investigational grants from Amgen AstraZeneca, Bayer, Bial, Boehringer Ingelheim, Merck Serono, Novartis, Orion, Pfizer, Roche Diagnostics, Servier, Vifor PHarma. F.F. has received speaker and consultancy fees or advisory board participation fees from AstraZeneca, Novartis, and Servier. J.M. has received speaker and consultancy fees, advisory board participation fees or investigational grants from AstraZeneca, Bayer Healthcare, Bial, Ferrer, Menarini, Merck Sharp and Dhome, Merck Portugal, Novartis, Pfizer/BMS, and Servier J.F. reports consultancy and lecture fees from Amgen, Astra-Zeneca, Boehringer Ingelheim and Novartis. D.B. has received speaker and consultancy fees, advisory board participation fees or investigational grants from Amgen, AstraZeneca Pharmaceuticals, Boehringer Ingelheim, Linde Saúde, Merck Portugal, Novartis, Orion, Pfizer, Roche Diagnostics, Servier, and Vifor Pharma. Publisher Copyright: © 2021 Sociedade Portuguesa de Cardiologia
Palavras-chave
Beta-blockers Heart failure Heart failure prognosis-modifying drugs Heart failure with reduced ejection fraction Mineralocorticoid receptor antagonists Sacubitril/valsartan SGLT2-inhibitors Treatment optimization Cardiology and Cardiovascular Medicine SDG 3 - Good Health and Well-being