Modern Therapeutic Strategies for Chronic Heart Failure: A Review of Pharmaco- and Non-Drug Approaches, New Drugs and Personalized Therapy

Abstract

Chronic heart failure remains one of the leading causes of hospitalization and mortality worldwide, despite significant progress in drug therapy in recent decades.  The leading international recommendations have formed the concept of the "four cornerstones" of pharmacotherapy of heart failure with reduced ejection fraction — inhibitors of the renin-angiotensin-aldosterone system or angiotensin receptor antagonists/non-lysine inhibitors, beta-blockers, antagonists of mineralocorticoid receptors and sodium-glucose cotransporter type 2 inhibitors, supplemented by diuretics and several auxiliary agents.   At the same time, the role of non-drug interventions is increasing, including lifestyle modification, cardiac rehabilitation, implantation of resynchronization therapy devices, cardioverter defibrillators, the use of mechanical circulatory support devices and telemedicine monitoring. An active search for new pharmacological targets continues: guanylate cyclase stimulants (vericiguat), selective myosin activators (omecamtiv mecarbil), and new classes of nephron-saving and metabolic drugs are being studied. The purpose of the article is a comprehensive analysis of modern therapeutic strategies for chronic heart failure from the perspective of a combination of pharmacological and non-medicinal approaches, a discussion of the place of new drugs in the structure of therapy and substantiation of the principles of personalized patient management.  An overview of current international recommendations and key clinical trials is presented, and data on the impact of various strategies on the prognosis and quality of life of patients are systematized.      Special attention is paid to the problem of phenotypic heterogeneity of heart failure (HFrEF, HFmrEF, HFpEF), comorbidity, as well as the need to adapt therapeutic solutions to the individual risk profile, concomitant diseases and patient preferences.