Pharmacological Approaches to Heart Failure Management
Summary
Heart failure is a global health challenge marked by the heart’s inability to meet circulatory demands, leading to substantial morbidity and mortality. Pharmacological treatment centres on modulation of neurohormonal pathways, attenuation of maladaptive ventricular remodelling and relief of symptoms. Core therapies antagonise the renin–angiotensin–aldosterone system with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and mineralocorticoid receptor antagonists, while β-blockers mitigate sympathetic overactivity. Diuretics remain essential for volume control. Recent additions such as angiotensin receptor–neprilysin inhibitors and sodium–glucose cotransporter 2 inhibitors have further improved outcomes. Successful management hinges on individualised regimens, careful dose titration and adherence support. Emerging biomarker-guided strategies and integrated care models are refining treatment algorithms, signalling a shift towards precision medicine in heart failure care.
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Pharmacological Approaches to Heart Failure Management publication trend
The graph below shows the total number of articles in pharmacological approaches to heart failure management across all publications each year (not limited to Nature Index journals).
Technical terms
Renin–angiotensin–aldosterone system (RAAS): Hormonal cascade regulating blood pressure and fluid balance, targeted by ACE inhibitors, ARBs and mineralocorticoid receptor antagonists.
Angiotensin-converting enzyme inhibitor (ACEI): Drug class that prevents conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone release.
Angiotensin II receptor blocker (ARB): Compound that selectively blocks angiotensin II type 1 receptors, attenuating vasoconstrictive and pro-remodelling effects.
Guideline-directed medical therapy (GDMT): Evidence-based pharmacological regimen recommended by clinical guidelines for optimal heart failure management.
Ejection fraction (EF): Proportion of blood ejected from the left ventricle per contraction, used to classify heart failure phenotypes.
References
- Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular events in patients with heart failure: a meta-analysis of randomized controlled trials. BMC Cardiovascular Disorders (2017).
- Comparison of the Efficacy and Safety of Different ACE Inhibitors in Patients With Chronic Heart Failure. Medicine (2016).
- Rationale and design of a navigator‐driven remote optimization of guideline‐directed medical therapy in patients with heart failure with reduced ejection fraction. Clinical Cardiology (2019).
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