Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paper

José Silva-Cardoso, Cândida Fonseca, Fátima Franco, João Morais, Jorge Ferreira, Dulce Brito

Research output: Contribution to journalArticlepeer-review

Abstract

Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients' functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members' clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.

Original languageEnglish
Pages (from-to)975-983
Number of pages9
JournalRevista Portuguesa de Cardiologia (English Edition)
Volume40
Issue number12
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Aminobutyrates
  • Biphenyl Compounds
  • Consensus
  • Heart Failure/drug therapy
  • Humans
  • Prognosis
  • Quality of Life
  • Stroke Volume
  • Tetrazoles

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