Journal of Clinical Medicine (Sep 2021)

Looking for a Tailored Therapy for Heart Failure: Are We Capable of Treating the Patient Instead of the Disease?

  • Alessandro Fucili,
  • Paolo Cimaglia,
  • Paolo Severi,
  • Francesco Giannini,
  • Alberto Boccadoro,
  • Marco Micillo,
  • Claudio Rapezzi,
  • Luigi Tavazzi,
  • Roberto Ferrari

DOI
https://doi.org/10.3390/jcm10194325
Journal volume & issue
Vol. 10, no. 19
p. 4325

Abstract

Read online

After almost a decade of stagnation in clinical research for HF treatment, five large randomized trials recently published have supported the use of four new classes of drugs, namely: angiotensin receptor/neprilysin inhibitor, sodium–glucose co-transporters 2 inhibitors, soluble guanylate cyclase modulators, and myosin activators. Each treatment has proved to be beneficial for both long-term outcomes and quality of life. Beside their clinical relevance, all these novel treatments have a different mechanism of action beyond the usual neuro-hormonal blockage. These different pathways, together with the unquestionable clinical evidence, advocate a re-thinking of HF treatment and of the appropriate drug to integrate with the existing standard therapy, according to different characteristics of HFrEF patients. This study aimed to offer a synthetic overview of the mechanisms of action of the new drugs and to propose a more personalized approach, considering patients’ characteristics and safety profiles. To this end, we have identified seven profiles for patients with chronic heart failure with reduced ejection fraction and two for pre-discharge patients.

Keywords