Heart failure and new pharmacotherapy options

Zatajivanje srca je progresivna bolest koja je karakterizirana postupnim smanjenjem srčanog učinka, isprekidanog epizodama akutne dekompenzacije, koje često zahtijevaju hospitalizaciju. Zatajivanje srca često prate komorbiditeti koji pridonose povećanom morbiditetu i mortalitetu te smanjenoj kvaliteti života. Predviđa se da će zbog svjetskog starenja stanovništva sve veća učestalost ZS-a predstavljati još veći izazov za buduće zdravstvene sustave. Terapija ZS-a usmjerena je na dva pomalo različita cilja: smanjenje simptoma uz što je veće moguće usporenje progresije tijekom relativno stabilnih razdoblja i upravljanje akutnim epizodama dekompenzacije. Velika klinička ispitivanja pokazala su da je terapija usmjerena na mete izvan srca vrijednija u dugotrajnom liječenju zatajenja srca od tradicionalnih pozitivnih inotropnih sredstava. Opsežna ispitivanja pokazala su da ACE inhibitori, blokatori angiotenzin receptora, β blokatori i antagonisti aldosteronskog receptora produžuju život u bolesnika s kroničnim ZS-om. Nekoliko novih lijekova testirano je u pretkliničkim i ranim fazama kliničkih ispitivanja, ali nisu svi uspjeli pokazati stvarnu korist naspram standardnih lijekova. U međuvremenu, dva obećavajuća nova lijeka dodana su ESC smjernicama za liječenje zatajenja srca: ivabradin i sakubitril/valsartan.Heart failure is a progressive disease that is characterized by a gradual reduction in cardiac performance, punctuated by episodes of acute decompensation, often requiring hospitalization. Heart failure is frequently accompanied by comorbidities that contribute to increased morbidity and mortality and an impaired quality of life. It is projected that because of the worldwide aging of the population the increasing prevalence of HF will pose an even greater challenge to future healthcare systems. Treatment of HF is directed at two somewhat different goals: reducing symptoms while slowing progression as much as possible during relatively stable periods and managing acute episodes of decompensated failure. Large clinical trials have shown that therapy directed at noncardiac targets is more valuable in the long-term treatment of heart failure than traditional positive inotropic agents. Extensive trials have shown that ACE inhibitors, angiotensin receptor blockers, β blockers and aldosterone receptor antagonists prolong life in patients with chronic HF. Several new drugs have been tested in preclinical and early-phase clinical trials, but not all of them managed to show the real benefit over standard medications. Meanwhile, the two promising new drugs have been added to the ESC guidelines to treat heart failure: ivabradine and sacubitril/valsartan