From the Guidelines
The primary goals of heart failure treatment are to improve quality of life, reduce symptoms, prevent hospitalizations, and extend survival. According to the most recent and highest quality study, the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 1, the objectives in the management of heart failure include improving clinical status, functional capacity, and quality of life, preventing hospital admission, and reducing mortality.
Key Objectives
- Improve clinical status
- Improve functional capacity
- Improve quality of life
- Prevent hospital admission
- Reduce mortality
The study emphasizes that preventing heart failure hospitalization and improving functional capacity are important benefits to be considered if a mortality excess is ruled out 1. Neuro-hormonal antagonists, such as ACEIs, MRAs, and beta-blockers, have been shown to improve survival in patients with HFrEF and are recommended for treatment, unless contraindicated or not tolerated 1.
Treatment Strategies
- Use of neuro-hormonal antagonists (ACEIs, MRAs, and beta-blockers)
- Consideration of newer compounds, such as sacubitril/valsartan, for ambulatory HFrEF patients who remain symptomatic despite optimal therapy
- Lifestyle modifications, including sodium restriction, fluid restriction, regular physical activity, smoking cessation, and limiting alcohol intake
It is essential to note that the goals of treatment may vary depending on the stage of heart failure, with earlier stages focusing on reducing modifiable risk factors and later stages aiming to reduce morbidity and mortality 1. However, the primary objectives of improving quality of life, reducing symptoms, preventing hospitalizations, and extending survival remain the cornerstone of heart failure treatment.
From the FDA Drug Label
The primary objective of PARADIGM-HF was to determine whether sacubitril and valsartan, a combination of sacubitril and an RAS inhibitor (valsartan), was superior to an RAS inhibitor (enalapril) alone in reducing the risk of the combined endpoint of cardiovascular (CV) death or hospitalization for heart failure (HF)
The goals of heart failure treatment are to:
- Reduce the risk of cardiovascular death
- Reduce the risk of hospitalization for heart failure These goals are achieved by improving overall survival and reducing the incidence of cardiovascular mortality 2.
From the Research
Goals of Heart Failure Treatment
The primary goals of heart failure treatment include:
- Improving quality of life 3
- Reducing morbidity and mortality 4
- Managing symptoms and functional severity of heart failure 3
- Optimizing medical therapy to limit and/or reverse the signs and symptoms of heart failure 5
Treatment Strategies
Treatment strategies for heart failure include:
- Medical therapy, such as pharmacological and nonpharmacological strategies 5
- Device therapy, including cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) 5, 6, 7
- Behavioral modifications, such as dietary sodium and fluid restriction, and encouraging physical activity 5
- Surgical interventions, such as ventricular assist devices (VADs) and heart transplantation 5
Key Considerations
Key considerations in heart failure treatment include:
- Determining the cause of heart failure and diagnosing potential reversible causes 5
- Optimizing medical therapy based on the patient's severity of heart failure and LV dysfunction 5
- Monitoring patients closely for potential adverse effects of treatments, such as changes in blood pressure, renal function, and electrolytes 4