Straw, S orcid.org/0000-0002-2942-4574, McGinlay, M and Witte, KK orcid.org/0000-0002-7146-7105 (2021) Four pillars of heart failure: contemporary pharmacological therapy for heart failure with reduced ejection fraction. Open Heart, 8. e001585. ISSN 2053-3624
Abstract
The past two decades have heralded dramatic improvements in outcomes for people living with heart failure with reduced ejection fraction (HFrEF).1 The more widespread implementation of disease modifying pharmacological therapies,2 supported by landmark trials of renin-angiotensin system inhibitors3 and beta-blockers4 have improved longevity despite a background of an ageing and increasingly multimorbid population. Although the benefits of comprehensive pharmacological therapies are clear, the real-world attainment of target doses5 6 and utilisation of novel agents such as angiotensin receptor-neprilysin inhibitors (ARNI)7 remain low. Furthermore, HFrEF remains a disease associated with significant morbidity and reduced survival relative to those without HFrEF, even after taking into account comorbidities.8 Recently, trials have demonstrated improved outcomes in people with HFrEF receiving sodium-glucose co-transporter 2 inhibitors (SGLT2i).9 10 However, it is currently unclear how these agents will be used alongside established therapies. Now is therefore an opportune moment to pause and reflect on our current practice, barriers to further progress and how future guidelines might work better for our patients. In this viewpoint we summarise how our current linear approach, on a background of increasingly complex pharmacotherapy has the potential to cause confusion and consequent delays which could lead to even worse attainment of optimal therapies. On the other hand, a more parallel approach to the initiation and optimisation of the Four Pillars of Heart Failure would simplify our approach, yielding benefits for our patients and healthcare systems.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 16 Feb 2021 15:40 |
Last Modified: | 25 Jun 2023 22:34 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Identification Number: | 10.1136/openhrt-2021-001585 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:171078 |