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Feature Article

New therapies in chronic heart disease

Anthony G Brazzale, John J Atherton

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Abstract

Numerous pharmacological and device therapies now exist to reduce both morbidity and mortality in patients with chronic heart failure. Early diagnosis and institution of optimal therapy is key to achieving the best outcome for these patients. This article provides an overview of the treatment of chronic heart failure focusing on new and emerging therapies.

Key Points

  • Angiotensin converting enzyme (ACE) inhibitors (or angiotensin receptor blockers), beta blockers and mineralocorticoid receptor antagonists have all been shown to improve survival in patients with heart failure associated with a reduced left ventricular ejection fraction (HFrEF).
  • In selected patients with HFrEF, additional options may be considered, including sinus node inhibition (ivabradine), cardiac resynchronisation therapy, implantable cardioverter defibrillators, hydralazine/nitrates and intravenous iron.
  • A first-in-class angiotensin receptor neprilysin inhibitor was recently shown to be superior to an ACE inhibitor in patients with HFrEF.
  • The management of heart failure with a preserved left ventricular ejection fraction remains largely empiric, with the use of diuretics to treat congestion and the treatment of cardiovascular risk factors.

    Picture credit: © Corbis/Diomedia.com

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