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May 15, 2025
Optimized drug regimens may dramatically improve survival for patients with chronic heart failure, potentially reducing mortality by as much as 60%, according to leading cardiologists at the 91st Annual German Society of Cardiovascular Medicine Conference.
Dr. Birgit Assmus, head of the Heart Failure Department at the University Hospital of Giessen and Marburg, highlighted the importance of rapid diagnosis and immediate initiation of combination drug therapy for heart failure (HF). “The benefits of treatment appear very quickly,” she emphasized, urging clinicians to begin medication as soon as HF is diagnosed, even as investigations into underlying causes continue.
Quadruple Therapy: The New Standard
For patients with heart failure with reduced ejection fraction (HFrEF) or moderately reduced ejection fraction, the 2021 European Society of Cardiology (ESC) guidelines recommend a quadruple therapy approach:
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ACE inhibitors or angiotensin receptor/neprilysin inhibitors (ARNI)
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Beta-blockers
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Mineralocorticoid receptor antagonists (MRAs)
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Sodium-glucose cotransporter 2 (SGLT2) inhibitors
A loop diuretic is added for those with fluid retention. Landmark studies such as PARADIGM-HF and trials involving dapagliflozin have shown significant reductions in both cardiovascular mortality and hospitalizations-sometimes within just a month of starting therapy.
The Challenge of Timely Diagnosis
Despite these advances, delayed diagnosis remains a major barrier. The Swedish REVOLUTION HF study found that only 29% of patients with high natriuretic peptide levels received a heart failure diagnosis within a year, often waiting over a month for essential echocardiography. Dr. Assmus called for better support for general practitioners and faster access to cardiological diagnostics.
Treatment Sequence and Longevity Gains
Once diagnosed, the recommended sequence for starting quadruple therapy is:
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SGLT2 inhibitors-assess tolerability within a week
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MRAs-added with SGLT2 inhibitors, reassess after a week
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Beta-blockers-titrated over four weeks
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ARNI-introduced as blood pressure stabilizes
This approach can yield remarkable benefits. Analysis of major studies suggests that a 55-year-old patient could gain an extra 6.3 years of life with quadruple therapy compared to conventional dual therapy. Even at age 80, patients may gain an additional 1.4 years.
Beyond Medication: Devices and Telemonitoring
For patients not responding to optimal medication, device-based therapies-such as pacemakers, implantable defibrillators, and cardiac resynchronization-can be considered. Telemonitoring, though underutilized, offers the potential for life-saving remote management.
Arrhythmia management, especially in those with atrial fibrillation, is also key. Maintaining normal rhythm can reduce both mortality and hospital admissions, even in advanced stages of HF.
New Horizons in Heart Failure Treatment
The future may bring even more options. Vericiguat, a soluble guanylate cyclase stimulator, is being studied for patients who worsen despite optimal therapy or cannot tolerate standard drugs. The ongoing VICTOR study will clarify its role in reducing cardiovascular deaths and hospitalizations.
Iron deficiency, common in HF, can be treated with intravenous iron carboxymaltose, which improves symptoms and reduces hospitalizations according to recent studies and meta-analyses.
For heart failure with preserved ejection fraction, SGLT2 inhibitors and diuretics remain the mainstays, but new agents like the nonsteroidal MRA finerenone have shown promise in reducing hospitalizations and cardiovascular deaths, particularly in patients with diabetic nephropathy.
Disclaimer:
This article is for informational purposes only and is based on recent conference presentations and published studies. It does not constitute medical advice. Patients should consult their healthcare providers before making any changes to their heart failure treatment. The findings discussed are subject to ongoing research and may evolve as new evidence emerges.
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