Cor Vasa 2022, 64(4):441-454 | DOI: 10.33678/cor.2022.079

(Optimizing Foundational Therapies in Patients With HFrEF. How Do We Translate These Findings Into Clinical Care? Translation of the document prepared by the Czech Society of Cardiology)

Filip Máleka, Miloš Táborskýb
a Kardiovaskulární centrum, Nemocnice Na Homolce, Praha
b I. interní klinika – kardiologická, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc

Vzhledem k vysokému riziku nežádoucích účinků u pacientů se srdečním selháním a sníženou ejekční frakcí (heart failure and reduced ejection fraction, HFrEF) existuje naléhavá potřeba zahájení a titrace farmakoterapie podle doporučených postupů (guideline-directed medical therapy, GDMT), která může snížit morbiditu a riziko úmrtí. Doporučené postupy pro klinickou praxi nyní zdůrazňují nutnost včasného a rychlého zahájení léčby látkami s kardiovaskulárním přínosem. Při vědomí četných překážek ztěžujících zahájení a optimalizaci GDMT musí být cílem poskytovatelů zdravotní péče uvádět do praxe čtyři pilíře farmakoterapie kombinací čtyř lékových skupin, kterou dnes preferuje většina doporučených postupů pro klinickou praxi: inhibitory receptoru pro angiotenzin II a neprilysinu, beta-blokátory, antagonisty mineralokortikoidních receptorů a inhibitory sodíko-glukózového kotransportéru 2. I když u vysokého procenta pacientů s HFrEF nejsou přítomny žádné klinické kontraindikace GDMT, přesto jim tato léčiva nejsou předepisována. Včasné zahájení kombinační léčby s nízkými dávkami by měla snášet většina pacientů. Při hledání maximální tolerované GDMT bude nicméně nutno zvažovat i faktory na straně pacientů, jako jsou jejich hemodynamické poměry, křehkost a laboratorní hodnoty. Další významnou možnost pro úspěšné provádění GDMT představuje zahájení GDMT během hospitalizace pro akutní srdeční selhání. Pro omezení polypragmazie a snížení rizika nežádoucích účinků lze konečně zvažovat i vysazení léčiv bez zjevného přínosu pro kardiovaskulární systém. Snížení morbidity a mortality pacientů s HFrEF si vyžádá další prospektivní studie zaměřené na optimální provádění farmakoterapie čtyřkombinací. (J Am Coll Cardiol Basic Trans Science 2022;7:504-517) © 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. Jde o článek vydaný pod licencí CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/). ISSN 2452-302X, https://doi.org/10.1016/j.jacbts.2021.10.018

Keywords: Antagonisté mineralokortikoidních receptorů, Beta-blokátory, Inhibitor receptoru pro angiotenzin II a neprilysinu, Inhibitory sodíko-glukózového kotransportéru 2

Received: July 11, 2022; Accepted: July 12, 2022; Published: September 1, 2022  Show citation

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Málek F, Táborský M. (Optimizing Foundational Therapies in Patients With HFrEF. How Do We Translate These Findings Into Clinical Care? Translation of the document prepared by the Czech Society of Cardiology). Cor Vasa. 2022;64(4):441-454. doi: 10.33678/cor.2022.079.

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Optimizing Foundational Therapies in Patients With HFrEF. How Do We Translate These Findings Into Clinical Care?

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