Medikamentöse Therapie der Herzinsuffizienz

Zusammenfassung

Die chronische Herzinsuffizienz nimmt aufgrund einer veränderten Altersstruktur der Bevölkerung, aber auch einer verbesserten medizinischen (Akut-)Versorgung kardiovaskulärer Erkrankungen an Inzidenz und Prävalenz zu. Unbehandelt hat sie eine schlechte Prognose – (rezidivierende) Hospitalisierungen stellen ein zunehmendes gesundheitsökonomisches Problem dar. Fortschritte in der Therapie der Patienten durch moderne Substanzen und konsequente Umsetzung der Therapieempfehlungen können die Prognose der Betroffenen deutlich verbessern. Neben der Etablierung der Mineralokortikoid-Rezeptor-Antagonisten bereits in milderen Stadien der systolischen Herzinsuffizienz und der Therapie mit dem I_f-Kanal-Blocker Ivabradin verspricht insbesondere der neue Angiotensin-Rezeptor-/Neprilysin-Inhibitor Sacubitril/Valsartan eine Verbesserung der Prognose. Daneben rücken zunehmend Diagnostik und Therapie prognosemodifizierender Komorbiditäten weiter in den Fokus. Die im Sommer 2016 vorgestellten aktualisierten Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) fassen den aktuellen Stand der Evidenz zusammen und geben Empfehlungen zur zeitgemäßen Therapie der Herzinsuffizienz.

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