Latest pharmaceutical approaches across the spectrum of heart failure.

Abstract

Despite major advances in prevention and medical therapy, heart failure (HF) remains associatedwith high morbidity and mortality, especially in older and frailer patients. Therefore, acomplete, guideline-based treatment is essential, even in HF patients with conditionstraditionally associated with a problematic initiation and escalation of the medical HFtherapy, such as chronic kidney disease and arterial hypotension, as the potential adverse effects areovercome by the overall decrease of the absolute risk. Furthermore, since the latestdata suggest that the benefit of a combined medical therapy (MRA, ARNI, SGLT2i,beta-blocker) may extend up to a LVEF of 65%, further trials on these subgroups ofpatients (HFmrEF, HFpEF) are needed to re-evaluate the guideline-directed medicaltherapy across the HF spectrum. In particular, the use of SGLT2i was recentlyextended to HFpEF patients, as evidenced by the DELIVER and EMPEROR-preservedtrials. Moreover, the indication for other conservative treatments in HF patients, suchas the intravenous iron supplementation, was accordingly strengthened in the latestguidelines. Finally, the possible implementation of newer substances, such as finerenone, in guideline-directed medical practice for HF is anticipated with great interest.