PMID- 38285236 OWN - NLM STAT- MEDLINE DCOM- 20240318 LR - 20240318 IS - 1573-7322 (Electronic) IS - 1382-4147 (Linking) VI - 29 IP - 2 DP - 2024 Mar TI - The role and application of current pharmacological management in patients with advanced heart failure. PG - 535-548 LID - 10.1007/s10741-024-10383-0 [doi] AB - In the last decades, several classifications and definitions have been proposed for advanced heart failure (ADVHF) patients, including clinical, functional, hemodynamic, imaging, and electrocardiographic features. Despite different inclusion criteria, ADVHF is characterized by some common items, such as drug intolerance, low arterial pressure, multiple organ dysfunction, chronic kidney disease, and diuretic use dependency. Additional features include fatigue, hypotension, hyponatremia, and unintentional weight loss associated with a specific laboratory profile reflecting systemic multiorgan dysfunction. Notably, studies evaluating guideline-directed medical therapy recently endorsed by guidelines in stable HF, including the 4 drug classes all together (i.e., betablocker, mineral corticoid antagonist, renin angiotensin inhibitors/neprilysin inhibitors, and sodium glucose transporter inhibitors), remain scarcely analyzed in ADVHF and New York Heart Association (NYHA) Class IV. Additionally, due to the common conditions associated with advanced stages, the balance between drug tolerance and potential benefits of the contemporary use of all agents is questioned. Therefore, less hard endpoints, such as exercise tolerance, quality of life (QoL) and self-competency, are not clearly demonstrated. Specific analyses evaluating outcome and rehospitalization of each drug provided conflicting results and are often limited to subjects with stable conditions and less advanced NYHA class. Current European Society of Cardiology/American Heart Association (ESC/AHA) Guidelines do not indicate the type of treatment, dosage, and administration modalities, and they do not suggest specific indications for ADVHF patients. Due to these concerns, there is an impelling need to understand what drugs may be used as the first line, what management leads to the better outcome, and what is the best treatment algorithm in this setting. In this paper, we summarize the most common pitfalls and limitations for the use of the traditional agents, and we propose a personalized approach aiming at preserve drug tolerance and maintaining adverse event protection and satisfactory QoL. CI - (c) 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. FAU - Palazzuoli, Alberto AU - Palazzuoli A AUID- ORCID: 0000-0002-6235-984X AD - Cardiovascular Diseases Unit, Cardiothoracic and Vascular Department, Le Scotte Hospital, University of Siena, Viale Bracci 12, 53100, Siena, Italy. palazzuoli2@unisi.it. FAU - Ruocco, Gaetano AU - Ruocco G AD - Cardiology Unit, "Buon Consiglio Hospital" Fatebenefratelli, Naples, Italy. FAU - Del Buono, Marco Giuseppe AU - Del Buono MG AD - Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, Rome, Italy. FAU - Pavoncelli, Simona AU - Pavoncelli S AD - Cardiovascular Diseases Unit, Cardiothoracic and Vascular Department, Le Scotte Hospital, University of Siena, Viale Bracci 12, 53100, Siena, Italy. FAU - Delcuratolo, Elvira AU - Delcuratolo E AD - Cardiovascular Diseases Unit, Cardiothoracic and Vascular Department, Le Scotte Hospital, University of Siena, Viale Bracci 12, 53100, Siena, Italy. FAU - Abbate, Antonio AU - Abbate A AD - Berne Cardiovascular Research Center, Division of Cardiology and Heart and Vascular Center, University of Virginia-School of Medicine, Charlottesville, VA, USA. FAU - Lavie, Carl J AU - Lavie CJ AD - John Ochsner Heart and Vascular Institute Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA. LA - eng PT - Journal Article PT - Review DEP - 20240129 PL - United States TA - Heart Fail Rev JT - Heart failure reviews JID - 9612481 RN - 0 (Diuretics) RN - 0 (Antihypertensive Agents) SB - IM MH - United States MH - Humans MH - *Quality of Life MH - *Heart Failure MH - Weight Loss MH - Diuretics/therapeutic use MH - Antihypertensive Agents/therapeutic use OTO - NOTNLM OT - Advance HF OT - Drugs intolerance OT - HF guidelines OT - Therapy EDAT- 2024/01/29 12:44 MHDA- 2024/03/18 06:42 CRDT- 2024/01/29 11:17 PHST- 2024/01/09 00:00 [accepted] PHST- 2024/03/18 06:42 [medline] PHST- 2024/01/29 12:44 [pubmed] PHST- 2024/01/29 11:17 [entrez] AID - 10.1007/s10741-024-10383-0 [pii] AID - 10.1007/s10741-024-10383-0 [doi] PST - ppublish SO - Heart Fail Rev. 2024 Mar;29(2):535-548. doi: 10.1007/s10741-024-10383-0. Epub 2024 Jan 29.