Stable patient with heart failure - the fact or the myth?
Frączek-Jucha, M.; Nessler, J.
Polski Merkuriusz Lekarski Organ Polskiego Towarzystwa Lekarskiego 49(286): 245-249
2020
ISSN/ISBN: 1426-9686 PMID: 32827419 Document Number: 18256
A treated patient with heart failure (HF), whose signs and symptoms have remained generally unchanged for at least 1 month is said to be 'stable'. Majority of patients with heart failure who are properly treated complain of slight symptoms described as functional class I and II NYHA. There is a belief that oligosymptomatic patients with heart failure have a good prognosis. Nevertheless, results of registries and randomized trials (e.g. ESC-HF-LT-R, CHARM, EMPHASIS-HF, PARADIGM-HF) disclosed that there is high risk of death and hospitalization for heart failure. Consequently, risk of every patient with heart failure should be evaluated with the use of validated scales - for example MAGGIC. Even in mild symptoms, remodeling of a left ventricle and dysfunction of the heart is progressing. It was revealed in the TRED-HF trial that withdrawal of guideline-directed medical therapy causes deterioration of clinical state in patients who were devoid of HF symptoms and presented improvement of echocardiographic parameters (left ventricle ejection fraction, left ventricle end diastolic volume) and laboratory parameters (N-terminal pro-B-type natriuretic peptide). This fact indicates that a chronic therapy in HF is necessary even in a situation where symptoms disappear, and heart function normalizes. An analysis of QUALIFY and ESC-HF-LT-R registries revealed that minority of patients with HF are treated according to current guidelines and doses of medications are not optimized. This management leads to deterioration of patient's prognosis. In addition to standard therapies (beta blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, ivabradine), novel drugs (e.g. sacubitril/valsartan) and individualized medical procedures should be applied in therapy.
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