ESC-Leitlinien – Chronische Herzinsuffizienz – Was hat sich geändert?

Die chronische Herzinsuffizienz zählt zu den häufigsten internistischen Erkrankungen. In Europa sind hiervon zirka 15 Millionen Menschen betroffen und 2006 war die Diagnose „Herzinsuffizienz“ erstmals die häufigste Einweisungsdiagnose in Deutschland. Der vorliegende Artikel beschäftigt sich mit den neuesten Erkenntnissen im Bereich „Herzinsuffizienz“, basiert auf den aktuellen europäischen Guidelines aus dem Jahr 2012. Es wird vor allem auf die Unterschiede im Vergleich zu der älteren Version aus dem Jahr 2008 hingewiesen. So wurde in der Stufentherapie der chronischen Herzinsuffizienz der Einsatz der Mineralocorticoid-Rezeptor-Antagonisten neu bewertet und Ivabradin als zusätzlicher Herzfrequenzsenker neu implementiert. Bei der kardialen Resynchronisationstherapie erfolgte eine differenzierte Bewertung hinsichtlich des jeweiligen Evidenzgrades. Ein wesentlicher Akzent liegt neben dem Einsatz von leitlinienkonformen Medikamenten auch auf den in den Leitlinien empfohlenen Zieldosen der jeweiligen Substanzen, was mit einem deutlichen Überlebensvorteil verbunden ist.

Chronic heart failure is one of the most frequent diseases of internal medicine. In Europe about 15 million people are afflicted and in 2006 the diagnosis „heart failure“ was for the first time in Germany the most frequent diagnosis for hospital admission. The present article discusses the most recent developments in the field „heart failure“ on the basis of the current European guidelines published in 2012. Particular emphasis is placed on changes in comparison to the older version published in 2008. This, in the stepwise therapy for chronic heart failure the use of mineralocorticoid receptor antagonists has been reassessed and ivabradine as an additional heart rate-reducing agent has been implemented. For cardiac resynchronization therapy there is a differentiated evaluation with regard to the respective level of evidence. Besides the use of guideline-conform drugs, special emphasis is placed in the guidelines on the recommended target doses of the individual substances which are associated with a marked improvement in survival.

Key words

Chronic heart failure - ESC guidelines 2012 - stepwise therapy - mineralocorticoid receptor antagonists - device therapy

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