Sample Article Summary on Current Drug Therapy in Chronic Heart Failure

Berliner& Bauersachs’s 2017 article titled “Current Drug Therapy in Chronic Heart Failure: The New Guidelines of The European Society of Cardiology (ESC)” argues that congestive heart failure is morbidity that affects many people across the world due to the increase of the aging population. Additionally, it suggests that the prognosis for HF is poor without proper treatment or therapy. As such, the paper provides an overview of the pharmacological treatment and management of patients with heart failure conditions involving neurohormonal inhibitions using various means, such as beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), and mineralocorticoid receptor antagonists (MRAs). It also provides an overview of pathophysiologic issues that must be considered when prescribing therapy for heart failure.

Berliner and Bauersachs posit that beta-blockers are recommended for patients with HF caused by systolic dysfunction, but they should be administered to HF patients with caution. As such, the titration of beta-blockers can be managed by the primary care physicians if accurately administered in the prescribed dosage. The article suggests that the initial dosage should be increased in clinical settings or doubled after every two or four weeks once the HF patient starts receiving treatment. This should be done until the patient is unable to tolerate higher levels of beta-blockers in the body system. The authors also assert that symptoms such as worsening heart failure, an increase of heart rate, and altered myocardial metabolism should prompt the evaluation and check-up of the patient (Berliner & Bauersachs, 2017). The assessment is meant to determine whether diuretic levels should be increased or the beta-block dosage levels be reduced. beta-blockers should only be administered to patients when the progression of the disease has slowed down.

The article argues that ACE inhibitors are also recommended for patients with HF caused by systolic dysfunction. ACEIs are used to block or inhibit the effects of angiotensin-II. Furthermore, Angiotensin-II is argued to have adverse effects, such as an increase in peripheral vascular resistance, increased afterload, activation of the sympathetic nervous system, stimulation of vascular and myocardial fibrosis among others, on HF patients. ACEIs should be administered to patients with HF conditions at a tolerated dosage to achieve adequate inhibition of the angiotensin-II in the patient’s system (Kantor & Redington, 2010).  Nevertheless, the authors mention that some patients are unable to tolerate ACEIs at higher dosage levels; thus, they should be subjected to angiotensin receptor blockers (ARBs).

Berliner & Bauersachs argue that MRAs are recommended to patients with HF caused by a history of rest dyspnea. Glucocorticoids attempt to activate MRA receptors, thus leading to several effects to the patient’s system leading to a decrease in cardiac output, reduced renal flow, hypertension, reduced coronary blood flow, increased collagen synthesis by cardiac fibroblasts, myocardial hypertrophy, among others (Berliner & Bauersachs, 2017). The authors further posit that outside the tolerated clinical MRAs dosage, it may lead to severe hyperkalemia and increased mortality. As such, it should not be administered to patients’ who are unable to tolerate low or high MRAs dosage levels.

Congestive HF is becoming prevalent across the world. In this regard, the article argues that HF prognosis is unfavorable without therapy. It suggests that physicians should consider the clinical trials, dosage levels, and the tolerance of HF patients to withstand the effects of beta-blockers, ACEIs, and MRAs (Kantor & Redington, 2010). Lastly, physicians should administer these treatments at favorable levels to reduce adverse effects and reduce mortality rates.

 

 

Reference

Berliner, D., & Bauersachs, J. (2017). Current drug therapy in chronic heart failure: The new guidelines of the European society of cardiology (ESC). Korean Circulation Journal47(5), 543-554. Retrieved from https://synapse.koreamed.org/search.php?where=aview&id=10.4070/kcj.2017.0030&code=0054KCJ&vmode=FULL

Kantor, P. F., & Redington, A. N. (2010). Pathophysiology and management of heart failure in repaired congenital heart disease. Heart failure clinics, 6(4), 497-506. Retrieved from https://www.heartfailure.theclinics.com/article/S1551-7136(10)00077-2/abstract