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Herzinsuffizienzleitlinien 2021 der ESC

Guidelines of the ESC 2021 on heart failure

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Zusammenfassung

Die neuen Leitlinien der European Society of Cardiology (ESC) für die Diagnose und Therapie der akuten und der chronischen Herzinsuffizienz beinhalten eine neue Benennung der Herzinsuffizienz mit mild reduzierter Ejektionsfraktion (HFmrEF, EF: 41–49 %, früher „mid-range“, jetzt „mildly reduced“); für diese Form der Herzinsuffizienz gibt es erstmals Empfehlungen zur Therapie mit den Standardmedikamenten, die auch bei HFrEF eingesetzt werden. Neu ist ebenso eine Klasse-I-Empfehlung für die Behandlung mit SGLT2(„sodium-glucose linked transporter 2“)-Inhibitoren (SGLT2i) bei Patienten mit HFrEF unabhängig vom Vorliegen eines Diabetes mellitus. Hervorzuheben ist, dass alle HFrEF-Patienten mit einer 4‑fach-Kombination aus Angiotensinrezeptor-Neprilysininhibitor (ARNI) bzw. ACE(„angiotensin-converting enzyme“)-Hemmer, Betablocker, Mineralokortikoidrezeptorantagonist (MRA) und SGLT2i behandelt werden sollen; es kann auch eine Primärtherapie mit ARNI erwogen werden ohne vorherige Gabe eines ACE-Hemmers. Bezüglich der Indikation zur primärprophylaktischen ICD(implantierbarer Kardioverter-Defibrillator)-Implantation besteht bei Patienten mit einer EF von 35 % oder weniger wie bisher eine Klasse-I-Indikation bei ischämischer, jedoch eine IIa-Indikation bei nichtischämischer Genese. Diese und weitere wichtige Neuerungen werden unter Einbeziehung der zugrunde liegenden klinischen Studien zusammengefasst.

Abstract

The new 2021 guidelines of the European Society of Cardiology (ESC) for the diagnosis and treatment of acute and chronic heart failure include a new terminology for heart failure (HF) with a left ventricular ejection fraction (EF) of 41–49%. This group of patients is now defined as HF with mildly reduced EF (HFmrEF; formerly mid-range). For this form of HF there are now for the first time recommendations for treatment with the standard medications, which are also used for HFrEF. Also new is a class I recommendation for the treatment of HFrEF patients with or without diabetes mellitus with sodium-glucose cotransporter 2 inhibitors (SGLT2i). It must be emphasized that all HFrEF patients should be treated with a combination of four drugs consisting of an angiotensin receptor-neprilysin inhibitor (ARNI) or angiotensin-converting enzyme (ACE) inhibitor, beta blocker, mineralocorticoid receptor antagonist (MRA) and SGLT2i. The primary treatment with ARNI can also be considered without the previous use of an ACE inhibitor. Primary prophylactic implantation of an implantable cardioverter defibrillator (ICD) continues to be a class I indication for patients with an EF of 35% or less in cases of ischemic cardiomyopathy; however, in cases of a non-ischemic cause there is a class IIa indication. This article summarizes these and further important novelties of the 2021 ESC guidelines taking the underlying clinical studies into account.

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Notes

  1. Die Verwendung des generischen Maskulinums dient ausschließlich der besseren Lesbarkeit. Angesprochen sind explizit alle Geschlechter (m/w/d).

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Authors and Affiliations

  1. Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    Johann Bauersachs & Samira Soltani

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  1. Johann Bauersachs
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  2. Samira Soltani
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Correspondence to Johann Bauersachs.

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Interessenkonflikt

J. Bauersachs hat von Novartis, Vifor, Bayer, Servier, Abiomed, Pfizer, Boehringer Ingelheim, AstraZeneca, Cardior, Daichii Sankyo, CVRx, BMS, MSD, Amgen, Corvia Honorare für Vortrags- und Beratertätigkeiten erhalten sowie Forschungsunterstützung für die Institution von Zoll, CVRx, Vifor, Abiomed. S. Soltani gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Bauersachs, J., Soltani, S. Herzinsuffizienzleitlinien 2021 der ESC. Herz 47, 12–18 (2022). https://doi.org/10.1007/s00059-021-05084-5

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