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Reviews in Cardiovascular Medicine  2021, Vol. 22 Issue (3): 573-584     DOI: 10.31083/j.rcm2203069
Special Issue: State-of-the-Art Cardiovascular Medicine in Asia 2021
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The 'diamond' approach to personalized drug treatment of heart failure with reduced ejection fraction
Hongbo Gan1, †, Heng Tang1, †, Yujie Huang2, Dan Wang3, Peng Pu1, *(), Zhong Zuo1, *()
1Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
2Department of Cardiology, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, 400060 Chongqing, China
3Department of Cardiology, Chongqing Red Cross Hospital, 400020 Chongqing, China
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Abstract:
Heart failure (HF) is a complex clinical syndrome with symptoms and signs due to cardiac dysfunction, leading to high hospitalization and morbidity. HF treatment has rapidly developed in recent decades, and breakthroughs have been made. Although conventional neurohormonal blockade therapies, including β-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs), significantly improve the prognosis of patients with heart failure with reduced ejection fraction (HFrEF), mortality and rehospitalization remain high. Therefore, new therapies are needed. Previous studies demonstrated that ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 (SGLT2) inhibitor, vericiguat, and omecamtiv mecarbil (OM) are beneficial for HFrEF. However, there is a lack of systematic review of the most optimal manner to use under various clinical conditions. This review summarizes the current knowledge regarding these therapies to give suggestions regarding clinical use timing, application scope, and optimal therapies under various conditions. Most importantly, we propose the HF diamond approach to express the necessity of conjunction of therapies. Different from the current guidelines, we suggest to use the diamond approach in an early and comprehensive manner at the beginning of ventricular remodeling in HFrEF to prevent further deterioration of HF and maximize the prognosis of patients.
Key words:  Heart failure      Diamond approach      New therapies      Individualized treatment     
Submitted:  14 July 2021      Revised:  03 August 2021      Accepted:  20 August 2021      Published:  24 September 2021     
Fund: 
2018ZDXM010/Science and Health Joint Medical Research Project of Chongqing
2020FYYX101/Science and Health Joint Medical Research Project of Chongqing
cstc2019jcyjmsxmX0433/Fundamental Science and Advanced Technology Research of Chongqing
*Corresponding Author(s):  pp841103@sina.com (Peng Pu); zzuo-cq@hotmail.com (Zhong Zuo)   
About author:  These authors contributed equally.

Cite this article: 

Hongbo Gan, Heng Tang, Yujie Huang, Dan Wang, Peng Pu, Zhong Zuo. The 'diamond' approach to personalized drug treatment of heart failure with reduced ejection fraction. Reviews in Cardiovascular Medicine, 2021, 22(3): 573-584.

URL: 

https://rcm.imrpress.com/EN/10.31083/j.rcm2203069     OR     https://rcm.imrpress.com/EN/Y2021/V22/I3/573

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