ABC Heart Fail Cardiomyop 2022; 2(1): 31-35
Pharmacological Treatment Sequencing for Heart Failure with Reduced Ejection Fraction
Important advances in knowledge about the treatment of heart failure (HF) have been made over the past three decades. In the 1980s, direct vasodilators, such as hydralazine and nitrate, and angiotensin-converting enzyme inhibitors (ACEis) were available. These drugs proved to be effective in the treatment of patients with different functional classes of HF. In CONSENSUS study, enalapril significantly reduced mortality, in patients with New York Heart Association (NYHA) class IV; number needed to treat – NNT, 6. as well as in patients with NYHA class II in SOLVD study, NNT 22. ,
In the late 1990s, mineralocorticoid receptor antagonists and beta-blockers were revealed as two drug classes with an impact on mortality in patients with HF with reduced ejection fraction (HFrEF). In RALES study, spironolactone significantly reduced mortality in patients with NYHA class III-IV NNT 10, leading to early study discontinuation. Beta-blockers, in turn, changed the natural history of HFrEF, as three different drugs (carvedilol, metoprolol succinate, and bisoprolol) reduced the relative risk of overall death by approximately 35% compared to placebo. –
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