Manejo y tratamiento medico actual de la insuficiencia cardíaca crónica

Abstract

Objective: The present investigation is a compilation of current clinical evidence about the management and medical treatment in patients with chronic heart failure to extrapolate the results of the main clinical trials to clinical practice. Materials and methods: An exhaustive search of the main clinical trials published in the main medical journals on the management and treatment of chronic heart failure was carried out, corroborating with the evidence published in the main current clinical practice guidelines on heart failure. Results: Classifying heart failure according to the stage, according to the functional class of the symptoms and according to the ejection fraction is important for the treatment, which aims to prevent symptoms of heart failure and to minimize the progression of ventricular dysfunction in asymptomatic patients with risk factors and heart disease, for symptomatic patients improve tolerance to physical activity, reduce hospitalizations and cardiovascular mortality. Treatment with IECA (or ARAII in case of intolerance or contraindication to IECA), beta blockers and mineralocorticoid receptor antagonists are drugs that modify the first line disease for treatment. The use of diuretics is reserved to improve congestive symptoms. The use of sacubitril/valsartan, ivabradine, digitalis, hydralazine and isosorbide dinitrate are reserved for a special group of patients who meet certain characteristics. Conclusions: The drugs indicated for the treatment of heart failure must be individualized for each type of patient in order to improve tolerance to physical activity, reduce hospitalizations and cardiovascular mortality.