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Dtsch Med Wochenschr 2024; 149(04): 157-165
DOI: 10.1055/a-2054-9636
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Therapie der Herzinsuffizienz mit reduzierter Pumpfunktion

Therapy of heart failure with reduced pump function
Amr Abdin
,
Michael Böhm
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Herzinsuffizienz ist eine der am stärksten zunehmenden kardiovaskulären Gesundheitsstörungen und belastet ökonomisch die Gesundheitssysteme weltweit [1]. Die Entwicklung neuer Behandlungsmöglichkeiten der Herzinsuffizienz mit reduzierter Ejektionsfraktion schreitet ständig voran und somit stehen mittlerweile vielfältige Therapieoptionen zur Verfügung. Folgend werden die wichtigsten Entwicklungen der letzten Jahre vorgestellt.

Abstract

HFrEF causes significant morbidity and mortality and represents a major public health burden. Recently, there have been significant scientific advances in the treatment of HFrEF, with ARNI, BB, MRA, and SGLT-2i forming the GDMT for HFrEF. Basic quadruple therapy has been shown to significantly reduce of HF hospitalizations, all-cause mortality, and cardiovascular mortality. In addition, new initiation and titration procedures have recently been introduced that may progressively improve the management and prognosis of HFrEF. Further efforts are also needed to improve the use of GDMT, which is currently underutilized.

Kernaussagen

  • Die grundlegende Quadrupeltherapie der HFrEF senkt deutlich die Zahl der Krankenhausaufenthalte, die Gesamtmortalität und die kardiovaskuläre Sterblichkeit bei Herzinsuffizienz.

  • Neben der HFrEF-Basistherapie sind neue medikamentöse Ansätze wie Guanylatzyklase-Aktivatoren und ein Myosin-Aktivator für die HFrEF-Behandlung vielversprechend.

  • Eine intravenöse Eisentherapie wird bei symptomatischen Patienten mit HFrEF, HFmrEF und Eisenmangel empfohlen, um HF-Symptome zu lindern und die Lebensqualität zu verbessern.

  • Die Phänotypisierung der HFrEF-Patienten kann zu einer personalisierten Anpassung der medikamentösen Therapien führen, wobei alle Medikamentenklassen zur Verbesserung der Ergebnisse eingesetzt werden können.

  • Eine intensive Strategie zur Einleitung und raschen Aufdosierung einer evidenzbasierten Behandlung vor der Entlassung und bei häufigen und sorgfältigen Nachsorgeuntersuchungen in den ersten 6 Wochen nach einem HF-Krankenhausaufenthalt wird empfohlen, um das Risiko einer erneuten Krankenhauseinweisung oder eines Todesfalls zu verringern.

Schlüsselwörter

Herzinsuffizienz - Therapie - GDMT - Device Therapie

Keywords

heart failure - therapy - GDMT - device therapy


Publication History

Article published online:
29 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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