2024 update in heart failure.
This 2024 update summarizes recent major advances in heart failure management, including broadened use of SGLT2 inhibitors and finerenone, rapid up-titration of quadruple therapy, and phenotype-specific options across the ejection fraction spectrum.
Background
Heart failure management has advanced substantially in recent years, and the 2023 ESC focused update of the 2021 heart failure guidelines introduced new recommendations based on recent trial evidence. The update reviews where the field stands across the spectrum of left ventricular ejection fraction and in the acute setting.
Key recommendations
Sodium-glucose co-transporter-2 (SGLT2) inhibitors and finerenone, a nonsteroidal mineralocorticoid receptor antagonist, are recommended for prevention of heart failure in patients with diabetic chronic kidney disease, and SGLT2 inhibitors are now recommended for treatment of heart failure across the entire ejection fraction spectrum. Quadruple therapy is well established for heart failure with reduced ejection fraction, and the STRONG-HF trial showed that rapid up-titration with close follow-up (a high-intensity care strategy) improved outcomes after acute heart failure. Patients with worsening heart failure may benefit from adding vericiguat.
Clinical implications
The update also highlights semaglutide for obese patients with heart failure with preserved ejection fraction (improving weight, quality of life, and walk distance in the STEP-HFpEF and STEP-HFpEF-DM trials), natriuresis-guided diuretic therapy, and disease-specific agents such as mavacamten for hypertrophic cardiomyopathy and tafamidis for transthyretin cardiac amyloidosis, alongside device and valvular therapies. Together these reflect a move toward earlier, more intensive, and phenotype-tailored heart failure care.
Category
Research
Source
ESC Heart Fail
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