Recent advances in pharmacological treatment of heart failure

Figures

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  FIGURE 1. The main trials testing drug therapy after the publication of the last European Society of Cardiology Guidelines. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 87 , 93 , 94 The distribution of the trials is based on the year of publication and the left ventricular ejection fraction at the time of the enrolment (the mean and range follow the inclusion criteria). The different colours identify the different drugs tested. ESC, European Society of Cardiology; HFmrEF, heart failure with mid‐range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction

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  FIGURE 2. The results of the CARMEN 38 and PROVE‐HF 3 studies. The first study compared the reverse remodelling and improvement of the left ventricular ejection fraction in patients undergoing treatment with enalapril, carvedilol and enalapril plus carvedilol for up to 18 months. The second tested the introduction of sacubitril‐valsartan in patients with heart failure with reduced ejection fraction who have already been treated with beta blockers and, in part, mineralocorticoid receptor antagonists, 75.8% of whom were previously treated with ACEi or angiotensin II receptor blockers. LVEF, left ventricular ejection fraction; LVESVI, left ventricular end‐systolic volume index

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  FIGURE 3. Therapeutic target of pharmacological treatment in patients with heart failure with reduced ejection fraction. ACEi and ARBs should be prescribed when ARNi are not tolerated. ACEi, ACE inhibitor; ARBs, Angiotensin II receptor blockers; ARNi, angiotensin receptor neprilysin inhibitor; HFrEF, heart failure with reduced ejection fraction; HR, heart rate; MRA, mineralocorticoid receptor antagonists; SGLT2i, sodium‐glucose cotransporter‐2 inhibitor