Pharmacological management of heart failure and device therapy in heart failure

Abstract

Pharmacological management of heart failure focuses on alleviation of symptoms and improvement of long-term outcome. For chronic heart failure with reduced ejection fraction, medical therapy is based on five drug classes which have been shown to reduce mortality, ACE inhibitors, angiotensin II-AT1 receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and the combination of the vasodilators hydralazine and isosorbide dinitrate, while symptoms of fluid retention and congestion are managed with loop diuretics. For patients with acute heart failure, medical therapy is supportive and consists of inotropes, vasopressors, and diuretics. Device therapy in the form of cardiac resynchronization therapy may be used to alleviate symptoms and prolong life in patients with symptomatic heart failure, reduced ejection fraction, and left bundle branch block. For patients with very low cardiac output and severe symptoms despite optimal medical therapy, mechanical circulatory support may be an option as a bridge to recovery or heart transplantation or as last resort therapy.