Effekter av befintliga och eventuella framtida läkemedelsbehandlingar på morbiditet och mortalitet hos patienter med hjärtsvikt.

Sammanfattning: Background:  Heart failure is a multidimensional phenomenon with high mortality. Heart failure is treated with angiotensin converting enzyme (ACE) - inhibitors or angiotensin receptor blockers (ARBs) that counteract neurohormonal stimuli that occur in heart failure, as well as providing vessel dilatation, which reduces symptoms and the need for hospitalization and increases survival. Despite this, only about 50% of heart failure patients survive 6 years after diagnosis with drug therapy, and as heart failure is increasing globally, due to improved care and treatment and increasing life expectancy of the population, there is a great need for new drugs such as LCZ696 that acts by dual inhibition of the renin - angiotensin - aldosterone system and neprilysin inhibition. Objective: The aim of this literature study was to evaluate the efficacy of current treatment and possible future treatments on mortality and morbidity in heart failure patients. Results: The examined articles show that treatment with ACE inhibitors in patients with symptomatic heart failure reduces the risk of total mortality by 16% over 3.5 years, reduces all-cause mortality or hospitalization due to heart failure with NNT (number needed to treat) = 10.4 over 3.5 years and increases median survival by 9.2 months over 12.1 years in patients with asymptomatic heart failure. Treatments with high-dose ACE inhibitors reduce mortality and hospitalization because of cardiovascular causes and hospitalizations from any cause by NNT = 30 over 3 years. Beta-blockers reduce sudden death and total mortality and cardiac death or non - fatal myocardial infarction with NNT = 38 and NNT = 23, respectively, over 12 months. Treatment with the new drug LCZ696 reduces mortality due to cardiovascular causes with NNT = 21 over 27 months, reduces hospitalizations due to heart failure with NNT = 36 over 27 months and reduces deaths from any cause with NNT = 34 compared to treatment with ACE inhibitors. Conclusion: The studies show that both ACE inhibitors and beta-blockers have clear beneficial effects in the treatment of heart failure. Treatment with ACE inhibitors for 3.5 years compared to placebo reduces total mortality by a NNT value of about 22. Treatment with beta-blockers during 1 year compared with placebo reduces total mortality by a NNT value of 24. Treatment with the new drug LCZ 696 for 27 months compared with ACE inhibitors reduces total mortality with a NNT value of 36. One remaining problem is that 50% of patients with severe heart failure (NYHA class IV) die within a year.