Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021–2022 in relation to Polish healthcare conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include drugs blocking the renin-angiotensin-aldosterone system, preferably angiotensin receptor antagonist/neprilysin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect — options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers — carvedilol and nebivolol), mineralocorticoid receptor antagonist, and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness has been confirmed in numerous prospective randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or the presence of arrhythmias. This article emphasizes the cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction value. We propose practical guidelines for the use of medicines, profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation, or antiplatelet and anticoagulant therapy are also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan, or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF are discussed

The importance of psychosocial factors in management of pulmonary arterial hypertension patients.

Pulmonary arterial hypertension (PAH) is significantly reshaping personal and professional lives of patients due to its chronic nature, varying clinical profile and uncertain perspectives of treatment. PAH is at this time an incurable disease, which requires to consider not only strictly medical dimension, but also the psychosocial aspects of care. This paper discusses therefore the psychological problems most commonly reported by PAH patients. It reviews the instruments used to assess them. We describe the relationships between the quality of life and depressive symptoms and the physical activity of the PAH patients, which have deep treatment-related consequences. The process of transition of teenage PAH patients into the adult care system is another sensitive phase, which requires careful preparation, individualised medical, psychosocial and educational approach, specific for the organisation of the Polish healthcare system. Palliative care of PAH patients has also been described, as it represents an integral part of treatment of this life-limiting disease. Swift recognition and adequate management of emotional and cognitive disruptions in PAH patients may contribute to their better co-operation with therapists, improvements in quality of life thus contributing to improved treatment outcomes