Current Pharmacological Treatment of Chronic Heart Failure

ACE-Inhibitors (or alternatively ARBs) and beta-blockers remain the first line treatment in systolic heart failure and should be up-titrated to evidence-based target doses. Recommendations for the use of mineralocorticoid receptor antagonists have been extended to all patients in NYHA class II-IV. Ivabradine should be considered in patients in sinus rhythm, EF < 35% and a heart rate > 70 beats/min despite maximum dosage of betablockers. Statins and oral anticoagulation in patients with sinus rhythm show no benefit for heart failure. Various drugs may cause worsening of heart failure and thus should be avoided due to safety concerns. Diuretics serve for symptom relieve in heart failure with fluid retention independent of the pump function. For heart failure with preserved ejection fraction in addition blood pressure control is of particular relevance.