Diuretics are first line drugs to improve symptoms of heart failure patients;
however they do not increase their long term survival. Administration of medications
blocking the neurohormonal activation, such as angiotensin converting enzyme(ACE)
inhibitors (alternatively, angiotensin II receptor blockers in patients with intolerance to
ACE inhibitors), mineralocorticoid receptor antagonists and beta blockers, lead to long
term improvement of both symptoms and prognosis of chronic heart failure patients
with reduced ejection fraction (EF<40%). Digoxin and ivabradine are also therapeutic
options for heart failure patients in specific clinical scenarios. LCZ 696 is the new
promising medication that improves more effectively cardiovascular outcomes in
chronic heart failure cases in comparison to ACE inhibitors. In contrast, there are no
available life prolonging medications for patients with preserved ejection fraction
(EF>50%), and treatment remains empirical targeting only to symptomatic
improvement. Treatment of comorbidities, including renal dysfunction, anemia and
depression, may improve the well-being and quality of life in chronic heart failure
patients, although evidence-based data are still limited.
Keywords: Angiotensin converting enzyme inhibitors, Angiotensin II receptor
blockers, Beta blockers, Digoxin, Diuretics, Heart failure, Hydralazine, Isosorbide
dinitrate, Ivabradine, Mineralocorticoid receptor antagonists.
