[II-AHAJS-01] 【基調講演】ガイドラインに基づく心不全薬物治療
In recent years, new therapeutic drugs have been introduced, and the pharmacological treatment of heart failure (HF) has made great progress. HF is classified according to left ventricular ejection fraction (EF); 40% or less as "HF with reduced EF (HFrEF)", 50% or more as "HF with preserved EF (HFpEF)", and 41 to 49 % as “HF with mildly reduced EF (HFmrEF)”.For HFrEF, ACE inhibitors/ARBs, β-blockers, and MRA are recommended as the fundamental drugs. The switch from ACE inhibitors/ARBs to ARNI sacubitril/valsartan and the addition of SGLT2 inhibitors, dapagliflozin and empagliflozin, are also recommended. Diuretics are required to improve organ congestion. In addition, the addition of HCN channel blocker, ivabradine, for sinus rhythm and heart rate ≥75 beats/min and the soluble GC stimulator, vericiguat, for recent worsening HF can be considered.For HFpEF, the interventions for comorbidities such as hypertension, coronary artery disease, and atrial fibrillation, and control of organ congestion with diuretics are recommended. SGLT2 inhibitors are recommended as class 2a. In addition, ARNI, MRA and ARB are also recommended as class 2b. For HFmrEF, SGLT2 inhibitors are recommended as class 2a, and ACE inhibitor, ARB, ARNI, MRA, and β-blocker as class 2b. I will overview the evidence and guidelines of pharmacological treatment of HF, which targeted patients with non-congenital (acquired) heart disease. Extrapolation of these information into patients with adult congenital heart disease (ACHD) may not be appropriate, however, they will be informative for their management.