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Pharmacotherapy of chronic heart failure in the elderly


Authors: Veselý Jiří
Authors‘ workplace: Lékařská fakulta v Hradci Králové, Univerzita Karlova ;  Kardiologická ambulance EDUMED
Published in: Geriatrie a Gerontologie 2023, 12, č. 1: 29-35
Category: Review Article

Overview

Pharmacological treatment of heart failure with reduced ejection fraction is supported by extensive evidence EBM, which includes dozens of clinical trials demonstrating the significant effectiveness of a wide range of molecules. The recent 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure abandon the previous common therapeutic sequence ACEI+BB…MRA…ARNI in HFrEF and recommend for most patients a treatment including 4 basic drug classes influencing the prognosis – ACEI/ARNI, BB, MRA and SGLT2 inhibitors. For the treatment of patients with HFmrEF and HFpEF, the publication of the results of the EMPEROR-Preserved and DELIVER studies, in which a significant effect of empagliflozin and dapagliflozin on the prognosis of patients and on their quality of life, brought new hope.

Keywords:

elderly – SGLT2 inhibitors – heart failure – HFpEF – HFrEF


Sources

1. McDonagh TA, Metra M, Adamo M, et al. ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42(36): 3599– 3726.

2. Málek F, Veselý J, Pudil R, et al. Souhrn Doporučených postupů Evropské kardiologické společ- nosti pro diagnostiku a léčbu srdečního selhání z roku 2021. Cor Vasa 2022; 64: 121–162.

3. Ponikowski P, Voors AA, Anker SD, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37(27): 2129–2200.

4. Rosano GMC, Moura B, Metra M, et al. Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021; 23(6): 872–881.

5. McMurray JJV, Packer M. How should we sequence the treatments for heart failure and a reduced ejection fraction? A redefinition of evidence-based medicine. Circulation 2021: 875–877.

6. Miller RJH, Howlett JG, Fine NM. A novel approach to medical management of heart failure with reduced ejection fraction. Can J Cardiol 2021; 37: 632–643.

7. Greene SJ, Butler J, Fonarow GC. Simultaneous or rapid sequence initiation of quadruple medical therapy for heart failure-optimizing therapy with the need for speed. JAMA Cardiol 2021; 6(7): 743–744.

8. Sharma A, Verma S, Bhatt DL, et al. Optimizing foundational therapies in patients with HFrEF. How do we translate these findings into clinical care? J Am Coll Cardiol Basic Trans Science 2022; 7: 504–517.

9. Málek F. Táborský M. Optimalizace léčby s použitím základních léků u pacientů se srdečním selháním se sníženou ejekční frakcí (HFrEF). Jak uplatňujeme nové poznatky v klinické praxi? Překlad dokumentu připravený Českou kardiologickou společností. Cor Vasa 2022; 64: 441–454.

10. Málek F. Táborský M. Komentář ke článku: Optimizing Foundational Therapies in Patients With HFrEF. How Do We Translate These Findings Into Clinical Care? Cor Vasa 2022; 64: 437–438.

11. Muntwyler J, Cohen-Solal A, Freemantle N, et al. Relation of sex, age and concomitant diseases to drug prescription for heart failure in primary care in Europe. Eur J Heart Fail 2004; 6(5): 663–668.

12. Stork S, Hense HW, Zentgraf C, et al. Pharmacotherapy according to treatment guidelines is associated with lower mortality in a community- based sample of patients with chronic heart failure: a prospective cohort study. Eur J Heart Fail 2004; 10(12): 1236–1245.

13. Berliner D, Bauersachs J. Drug treatment of heart failure in the elderly. Herz 2018; 43: 207–213.

14. Sica DA, Gehr TWB, Frishman WEH. Use of diuretics in the treatment of heart failure in older adults. Heart Fail Clin 2017; 13(3): 503– 512.

15. Hjalmarson A, Goldstein S, Fagerberg B, et al Effects of controlledrelease metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA 2000; 283(10): 1295–1302.

16. Flather MD, Shibata MC, Coats AJ, et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 2005; 26(3): 215–225.

17. Düngen H-D, Apostolovic S, Inkrot S, et al. Titration to target dose of bisoprolol vs. carvedilol in elderly patients with heart failure: the CIBIS-ELD trial. Eur J Heart Fail 2011; 13(6): 670–680.

18. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and cognestive heart faillure. N Engl J Med 1991; 325: 293–302.

19. The Consensus Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. N Engl J Med 1987; 316(23): 1429–1435.

20. Lindenfeld J, Albert NM, Boehmer JP, et al. (2010) HFSA 2010 comprehensive heart failure practice guideline. J Card Fail 2010; 16(6): e1–194.

21. Sanam K, Bhatia V, Bajaj NS, et al. Renin-angiotensin system inhibition and lower 30-day all-cause readmission in Medicare beneficiaries with heart failure. Am J Med 2016; 129: 1067–1073.

22. Aronow WS Treatment of heart failure with abnormal left ventricular systolic function in older adults. Heart Fail Clin 2017; 13(3): 467–483.

23. Ahmed A, Fonarow DC, Zhang Y, et al. Renin-aldosteron inhibition in systolic heart failure and chronic kidney disease. Am J Med 2012; 125: 399–410.

24. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999; 341(10): 709–717.

25. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011; 364(1): 11–21.

26. Eschalier R, McMurray JJ, Swedberg K, et al. Safety and efficacy of eplerenone in patients at high risk for hyperkalemia and/or worsening renal function: analyses of the EMPHASIS-HF study subgroups (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure). J Am Coll Cardiol 2013; 62(17): 1585– 1593.

27. Pitt B, Anker SD, Bushinsky DA, et al. Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a doubleblind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J 2011; 32(7): 820–828.

28. Butler J, Anker SD, Lund LH, et al. Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial. Eur Heart J 2022; 43(41): 4362–4373.

29. McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371(11): 993–1004.

30. Jhund PS, Fu M, Bayram E, et al. Efficacy and safety of LCZ696 (sacubitril- valsartan) according to age: insights from PARADIGM-HF. Eur Heart J 2015; 36(38): 2576– 2584.

31. McMurray JJV, Solomon SD, Inzucchi SE, et al. DAPA-HF trial committees and investigators. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019; 381: 1995–2008.

32. Packer M, Anker SD, Butler J, et al. EMPEROR-Reduced trial investigators. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020; 383: 1413–1424.

33. Martinez FA, Serenelli M, Nicolau JC, et al. Efficacy and safety of dapagliflozin in heart failure with reduced ejection fraction according to age: insights from DAPA-HF. Circulation. 2020; 141: 100–111.

34. Filippatos G, Anker SD, Butler J, et al.; EMPEROR-reduced trial committees and investigators. Effects of empagliflozin on cardiovascular and renal outcomes in heart failure with reduced ejection fraction according to age: a secondary analysis of EMPEROR-Reduced. Eur J Heart Fail 2022; 24(12): 2297–2304.

35. Haluzík M, Kubíčková M, Veselý J, et al. Expertní konsenzus k praktickým aspektům spolupráce kardiologa a diabetologa v péči o pacienty s chronickým srdečním selháním s redukovanou ejekční frakcí. Cor Vasa 2021; 63: 630–636.

36. Swedberg K, Komajda M, Bohm M, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 2010; 376(9744): 875–885.

37. Tavazzi L, Swedberg K, Komajda M, et al. Efficacy and safety of ivabradine in chronic heart failure across the age spectrum: insights from the SHIFT study. Eur J Heart Fail 2013; 15(11): 1296– 1303.

38. Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997; 336(8): 525–533.

39. Bourge RC, Fleg JL, Fonarow GC, et al. Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure. Am J Med 2013; 126(8): 701–708.

40. Armstrong PW, Pieske B, Anstrom KJ, et al. Vericiquat in patients with heart failure and reduced ejection fraction. N Engl J Med 2020; 382: 1883–1893.

41. Anker SD, Butler J, Filippatos G, et al. EMPEROR-preserved trial investigators. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 2021; 385: 1451–1461.

42. Freidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145: e895–e1032.

43. Solomon SD, McMurry JJV, Claggett B, et al.; for the DELIVER Trial Committees and Investigators. N Engl J Med 2022; 387: 1089–1098.

44. Böhm M, Butler J, Filippatos G, et al. Empagliflozin improves outcomes in patients with heart failure and preserved ejection fraction irrespective of age. J Am Coll Cardiol 2022; 80: 1–18.

45. Peikert A, Martinez FA, Vaduganathan M, et al. Efficacy and safety of dapagliflozin in heart failure with mildly reduced or preserved ejection fraction accoring to age: the DELIVER trial. Circ Heart Fail 2022; 15(10): e010080.

46. Ponikowski P, Kirwan B-A, Anker SD, et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet 2020; published online November 13, 2020.

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