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Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Advanced heart failure: guideline-directed medical therapy, diuretics, inotropes, and palliative care

Publikation: Bidrag til tidsskriftReviewForskningpeer review

DOI

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  3. Association of iron deficiency with incident cardiovascular diseases and mortality in the general population

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  1. Three decades of heart transplantation: experience and long-term outcome

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  2. Healthcare resource use of patients with transthyretin amyloid cardiomyopathy

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  3. Circulating Concentrations of C-Type Natriuretic Peptides Increase with Sacubitril/Valsartan Treatment in Healthy Young Men

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Vis graf over relationer

Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality of life and a major burden for the healthcare system. The number of patients that progress to an advanced stage of HF is growing. Only a limited proportion of these patients can undergo heart transplantation or mechanical circulatory support. The purpose of this review is to summarize medical management of patients with advanced HF. First, evidence-based oral treatment must be implemented although it is often not tolerated. New therapeutic options may soon become possible for these patients. The second goal is to lessen the symptomatic burden through both decongestion and haemodynamic improvement. Some new treatments acting on cardiac function may fulfil both these needs. Inotropic agents acting through an increase in intracellular calcium have often increased risk of death. However, in the recent Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial, omecamtiv mecarbil was safe and effective in the reduction of the primary outcome of cardiovascular death or HF event compared with placebo (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99; P = 0.03) and its effects were larger in those patients with more severe left ventricular dysfunction. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit, whereas patients without severe HF did not (P = 0.005 for interaction). Lastly, clinicians should take care of the end of life with an appropriate multidisciplinary approach. Medical treatment of advanced HF therefore remains a major challenge and a wide open area for further research.

OriginalsprogEngelsk
TidsskriftESC Heart Failure
Vol/bind9
Udgave nummer3
Sider (fra-til)1507-1523
Antal sider17
ISSN2055-5822
DOI
StatusUdgivet - jun. 2022

Bibliografisk note

© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

ID: 77930972