Cardiovasc Prev Pharmacother.  2020 Oct;2(4):113-133. 10.36011/cpp.2020.2.e17.

Update on the Pharmacotherapy of Heart Failure with Reduced Ejection Fraction

• Kim ES
• Youn JC
• Baek SH

• KMID: 2536949
• DOI: http://doi.org/10.36011/cpp.2020.2.e17

Abstract

Heart failure (HF) is an important cardiovascular disease because of the increasing prevalence, high morbidity and mortality, and rapid expansion of health care costs. Over the past decades, efforts have been made to modify the prognosis of patients with HF. Regarding HF with reduced ejection fraction (HFrEF), several drugs have shown to improve mortality and morbidity, based on large-scale randomized controlled trials, leading to a critical paradigm shift in its pharmacological treatment. The paradigm of HFrEF pathophysiology has shifted from cardiorenal disease to hemodynamic changes, and neurohormonal activation is currently considered the prime pathophysiological mechanism of HFrEF. This review summarizes evidence on the pharmacological management of HFrEF derived from major randomized controlled trials, which have accomplished improvements in survival benefits.

Keyword

Clinical trial; Drug therapy; Heart failure; Ventricular dysfunction

Figure

• 

  Figure 1. Timeline of patient enrollment (from the first year of enrollment) in clinical trials related to heart failure with reduced ejection fraction. ACEI = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; ARNI = angiotensin receptor–neprilysin inhibitor; BB = beta-blocker; CCB = calcium channel blocker; DRI = direct renin inhibitor; ERA = endothelin receptor antagonist; H-ISDN = hydralazine-isosorbide dinitrate; MRA = mineralocorticoid receptor antagonist; PDE = phosphodiesterase; sGC = soluble guanylate cyclase; SGLT2 = sodium-glucose co-transporter-2.

• 

  Figure 2. Changes in the HF paradigm and corresponding treatment targets.HF = heart failure.

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