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Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paper

2021-12Artigo científico Acesso aberto
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datacite.subject.fosCiências Médicas::Medicina Clínica
datacite.subject.sdg03:Saúde de Qualidade
datacite.subject.sdg04:Educação de Qualidade
datacite.subject.sdg17:Parcerias para a Implementação dos Objetivos
dc.contributor.authorSilva-Cardoso, José
dc.contributor.authorFonseca, Cândida
dc.contributor.authorFranco Fátima
dc.contributor.authorMorais, João
dc.contributor.authorFerreira, Jorge
dc.contributor.authorBrito, Dulce
dc.date.accessioned2026-01-07T14:37:25Z
dc.date.available2026-01-07T14:37:25Z
dc.date.issued2021-12
dc.description.abstractHeart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients’ functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members’ clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.eng
dc.description.abstractA insuficiência cardíaca (IC) com fração de ejeção reduzida (ICFEr) está associada a níveis elevados de hospitalização e mortalidade. A ICFEr também tem um impacto negativo na capacidade funcional e na qualidade de vida dos doentes, bem como na despesa em saúde. Nos últimos anos, surgiram novos medicamentos modificadores do prognóstico da ICFEr, originando um intenso debate na comunidade científica internacional em relação a uma mudança de paradigma para o tratamento da ICFEr. Neste artigo, relatamos a contribuição de um painel de especialistas portugueses em IC para o debate em curso. Com base na evidência clínica publicada mais recentemente e no julgamento clínico dos membros do painel, três princípios-chave são destacados: (i) sacubitril/valsartan deve ser preferido como terapia de primeira linha para a ICFEr, em vez de um inibidor da enzima de conversão da angiotensina ou um bloqueador do recetor da angiotensina; (ii) os quatro medicamentos básicos para a ICFEr são o inibidor do recetor da angiotensina e da neprilisina, os agentes bloqueadores beta-adrenérgicos, os antagonistas do recetor mineralocorticoide e os inibidores do cotransportador sódio-glucose 2, independentemente da presença de diabetes mellitus tipo 2; (iii) essas quatro classes de medicamentos para a ICFEr devem ser rapidamente introduzidas num período curto de 4-6 semanas, seguindo um protocolo de segurança, e depois tituladas durante as oito semanas seguintes.por
dc.description.sponsorshipMedical writer Duarte Oliveira (W4Research) collaborated in the preparation of this article, with financial support from Novartis Portugal. This article contains the authors’ opinion on the scientific contents addressed, which are expressed independently of Novartis. Novartis did not participate in the design, discussion of, or writing of this paper.
dc.identifier.citationJosé Silva-Cardoso, Cândida Fonseca, Fátima Franco, João Morais, Jorge Ferreira, Dulce Brito, Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paper, Revista Portuguesa de Cardiologia, Volume 40, Issue 12, 2021, Pages 975-983, ISSN 0870-2551, https://doi.org/10.1016/j.repc.2021.07.009.
dc.identifier.doi10.1016/j.repc.2021.07.009
dc.identifier.eissn2174-2030
dc.identifier.issn0870-2551
dc.identifier.urihttp://hdl.handle.net/10400.8/15246
dc.language.isoeng
dc.peerreviewedyes
dc.publisherElsevier
dc.relation.hasversionhttps://www.sciencedirect.com/science/article/pii/S0870255121003553?via%3Dihub
dc.relation.ispartofRevista Portuguesa de Cardiologia
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectHeart failure
dc.subjectHeart failure with reduced ejection fraction
dc.subjectHeart failure prognosis-modifying drugs
dc.subjectTreatment optimization
dc.subjectSacubitril/valsartan
dc.subjectSGLT2-inhibitors
dc.subjectBeta-blockers
dc.subjectMineralocorticoid receptor antagonists
dc.subjectInsuficiência cardíaca
dc.subjectInsuficiência cardíaca com fração de ejeção reduzida
dc.subjectDrogas modificadoras do prognóstico da insuficiência cardíaca
dc.subjectOtimização do tratamento
dc.subjectInibidores da SGLT2
dc.subjectBeta-bloqueadores
dc.subjectAntagonistas do recetor mineralocorticoide
dc.titleOptimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus papereng
dc.title.alternativeOtimização do tratamento da insuficiência cardíaca com fração de ejeção reduzida com fármacos modificadores de prognóstico: um documento de consenso de 2021 por especialistas em insuficiência cardíacapor
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage983
oaire.citation.issue12
oaire.citation.startPage975
oaire.citation.titleRevista Portuguesa de Cardiologia
oaire.citation.volume40
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameMorais
person.givenNameJoão
person.identifier.ciencia-id3614-652A-118E
person.identifier.orcid0000-0003-3406-2878
relation.isAuthorOfPublication3bc0f910-a460-461f-863a-1ca701ee597f
relation.isAuthorOfPublication.latestForDiscovery3bc0f910-a460-461f-863a-1ca701ee597f

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Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients’ functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members’ clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.
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