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03.02.2020 | Herzinsuffizienz | CME

Diagnostik und Therapie der chronischen Herzinsuffizienz

Update 2020

verfasst von: Prof. Dr. Gülmisal Güder, Prof. Dr. Georg Ertl, Prof. Dr. Christiane E. Angermann

Erschienen in: Herz

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Zusammenfassung

Herzinsuffizienz ist eine Systemerkrankung. Mit steigendem Alter der Bevölkerung nehmen weltweit ihre Prävalenz sowie die Bedeutung von Komorbiditäten für die Symptomatik, Krankheitsprogression und Prognose zu. Seit der letzten Version der europäischen Leitlinien zur Diagnostik und Therapie der Herzinsuffizienz 2016 wurden vielversprechende neue Medikamente sowie neue Device-basierte Monitoring- und Behandlungsoptionen verfügbar. Das immer breitere Spektrum diagnostischer und therapeutischer Möglichkeiten macht andererseits die Herzinsuffizienzbehandlung immer komplexer. Dieser Übersichtsartikel soll eine praxisnahe Hilfestellung bieten für die Versorgung herzinsuffizienter Patienten gemäß aktueller Evidenzlage.
Literatur
1.
Zurück zum Zitat Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128 CrossRef Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://​doi.​org/​10.​1093/​eurheartj/​ehw128 CrossRef
3.
Zurück zum Zitat Pieske B, Tschope C, de Boer RA et al (2019) How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. https://doi.org/10.1093/eurheartj/ehz641 CrossRef Pieske B, Tschope C, de Boer RA et al (2019) How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. https://​doi.​org/​10.​1093/​eurheartj/​ehz641 CrossRef
4.
Zurück zum Zitat Seferovic PM, Ponikowski P, Anker SD et al (2019) Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. https://doi.org/10.1002/ejhf.1531 CrossRef Seferovic PM, Ponikowski P, Anker SD et al (2019) Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. https://​doi.​org/​10.​1002/​ejhf.​1531 CrossRef
11.
Zurück zum Zitat Lund LH, Claggett B, Liu J et al (2018) Heart failure with mid-range ejection fraction in CHARM: characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum. Eur J Heart Fail 20(8):1230–1239. https://doi.org/10.1002/ejhf.1149 CrossRef Lund LH, Claggett B, Liu J et al (2018) Heart failure with mid-range ejection fraction in CHARM: characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum. Eur J Heart Fail 20(8):1230–1239. https://​doi.​org/​10.​1002/​ejhf.​1149 CrossRef
15.
17.
Zurück zum Zitat Maggioni AP, Anker SD, Dahlstrom U et al (2013) Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail 15(10):1173–1184. https://doi.org/10.1093/eurjhf/hft134 CrossRef Maggioni AP, Anker SD, Dahlstrom U et al (2013) Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail 15(10):1173–1184. https://​doi.​org/​10.​1093/​eurjhf/​hft134 CrossRef
18.
Zurück zum Zitat Mullens W, Damman K, Harjola VP et al (2019) The use of diuretics in heart failure with congestion—a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 21(2):137–155. https://doi.org/10.1002/ejhf.1369 CrossRef Mullens W, Damman K, Harjola VP et al (2019) The use of diuretics in heart failure with congestion—a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 21(2):137–155. https://​doi.​org/​10.​1002/​ejhf.​1369 CrossRef
24.
Zurück zum Zitat Wachter R, Senni M, Belohlavek J et al (2019) Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail 21(8):998–1007. https://doi.org/10.1002/ejhf.1498 CrossRef Wachter R, Senni M, Belohlavek J et al (2019) Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail 21(8):998–1007. https://​doi.​org/​10.​1002/​ejhf.​1498 CrossRef
25.
Zurück zum Zitat Rosano GMC, Tamargo J, Kjeldsen KP et al (2018) Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother 4(3):180–188. https://doi.org/10.1093/ehjcvp/pvy015 CrossRef Rosano GMC, Tamargo J, Kjeldsen KP et al (2018) Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother 4(3):180–188. https://​doi.​org/​10.​1093/​ehjcvp/​pvy015 CrossRef
28.
Zurück zum Zitat Lewis GD, Malhotra R, Hernandez AF et al (2017) Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency: the IRONOUT HF randomized clinical trial. JAMA 317(19):1958–1966. https://doi.org/10.1001/jama.2017.5427 CrossRef Lewis GD, Malhotra R, Hernandez AF et al (2017) Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency: the IRONOUT HF randomized clinical trial. JAMA 317(19):1958–1966. https://​doi.​org/​10.​1001/​jama.​2017.​5427 CrossRef
29.
Zurück zum Zitat Anker SD, Kirwan BA, van Veldhuisen DJ et al (2018) Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail 20(1):125–133. https://doi.org/10.1002/ejhf.823 CrossRef Anker SD, Kirwan BA, van Veldhuisen DJ et al (2018) Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail 20(1):125–133. https://​doi.​org/​10.​1002/​ejhf.​823 CrossRef
39.
Zurück zum Zitat Cleland JG, Abraham WT, Linde C et al (2013) An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 34(46):3547–3556. https://doi.org/10.1093/eurheartj/eht290 CrossRef Cleland JG, Abraham WT, Linde C et al (2013) An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 34(46):3547–3556. https://​doi.​org/​10.​1093/​eurheartj/​eht290 CrossRef
46.
Zurück zum Zitat Packer DL, Mark DB, Robb RA et al (2019) Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA 321(13):1261–1274. https://doi.org/10.1001/jama.2019.0693 CrossRef Packer DL, Mark DB, Robb RA et al (2019) Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA 321(13):1261–1274. https://​doi.​org/​10.​1001/​jama.​2019.​0693 CrossRef
47.
Zurück zum Zitat Brignole M, Pokushalov E, Pentimalli F et al (2018) A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS. Eur Heart J 39(45):3999–4008. https://doi.org/10.1093/eurheartj/ehy555 CrossRef Brignole M, Pokushalov E, Pentimalli F et al (2018) A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS. Eur Heart J 39(45):3999–4008. https://​doi.​org/​10.​1093/​eurheartj/​ehy555 CrossRef
52.
54.
Zurück zum Zitat Van Spall HGC, Rahman T, Mytton O et al (2017) Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. Eur J Heart Fail 19(11):1427–1443. https://doi.org/10.1002/ejhf.765 CrossRef Van Spall HGC, Rahman T, Mytton O et al (2017) Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. Eur J Heart Fail 19(11):1427–1443. https://​doi.​org/​10.​1002/​ejhf.​765 CrossRef
65.
Zurück zum Zitat Angermann CE, Assmus B, Anker SD et al (2018) Safety and feasibility of pulmonary artery pressure-guided heart failure therapy: rationale and design of the prospective CardioMEMS Monitoring Study for Heart Failure (MEMS-HF). Clin Res Cardiol 107(11):991–1002. https://doi.org/10.1007/s00392-018-1281-8 CrossRef Angermann CE, Assmus B, Anker SD et al (2018) Safety and feasibility of pulmonary artery pressure-guided heart failure therapy: rationale and design of the prospective CardioMEMS Monitoring Study for Heart Failure (MEMS-HF). Clin Res Cardiol 107(11):991–1002. https://​doi.​org/​10.​1007/​s00392-018-1281-8 CrossRef
67.
Zurück zum Zitat Ertl G, Angermann CE, Bekeredjian R et al (2016) 2016 Empfehlung Aufbau und Organisation von Herzinsuffizienz-Netzwerken (HF-NETs) und Herzinsuffizienz-Einheiten („Heart Failure Units“, HFUs) zur Optimierung der Behandlung der akuten und chronischen Herzinsuffizienz. Kardiologe 10:222. https://doi.org/10.1007/s12181-016-0072-6 CrossRef Ertl G, Angermann CE, Bekeredjian R et al (2016) 2016 Empfehlung Aufbau und Organisation von Herzinsuffizienz-Netzwerken (HF-NETs) und Herzinsuffizienz-Einheiten („Heart Failure Units“, HFUs) zur Optimierung der Behandlung der akuten und chronischen Herzinsuffizienz. Kardiologe 10:222. https://​doi.​org/​10.​1007/​s12181-016-0072-6 CrossRef
Metadaten
Titel
Diagnostik und Therapie der chronischen Herzinsuffizienz
Update 2020
verfasst von
Prof. Dr. Gülmisal Güder
Prof. Dr. Georg Ertl
Prof. Dr. Christiane E. Angermann
Publikationsdatum
03.02.2020
Verlag
Springer Medizin
Erschienen in
Herz
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-019-04877-z