CHRONIC HEART FAILURE: NEW TREATMENT STRATEGIES

Аннотация

Heart failure is a condition where our heart can’t pump enough heart blood to meet the body demand. It is also called congestive heart failure or cardiomyopathy which represents the weakness of heart muscle . When heart is unable to pump effectively it’s called systolic heart failure or unable to fill properly called diastolic heart failure. In both of the cases blood output is reduced . Ejection fraction in systolic heart failure is reduced and in diastolic heart failure it is preserved . Heart failure is a complex clinical syndrome with signs and symptoms that result from any structural and functional impairment of ventricular filling or ejection of blood . It’s a growing health and economic burden for the united state . In 2017 , there were 1.2 million heart failure hospitalization in the US among ~1 million patient with diagnosis of heart failure.This shows that a 26% increase in the heart failure hospitalizations from 2013 to 2017 . From 2000 - 2013 the rise was not this much high but lately it has been growing every year so thats why it’s a topic of growing concern and manage it appropriately.Pathophysiology of heart failure involves a vicious cycle in which reduced cardiac output as a compensatory response activates RAAS (Renin Angiotensin Aldosterone system) pathway and Sympathetic system, these system’s causes vasoconstriction,increases heart rate and blood pressure makes even harder for heart to pump , increased aldosterone level also promotes ventricular remodeling, myocardial scarring and vascular injury, hence worsening the disesase. Also on the other hand Natriuretic peptide system is also activated to protect heart which promotes vasodilation, Sodium/water excretion and inhibit cardiac remodelling. So most of the drugs used in heart failure therapy aim to inhibit RAAS Pathway and sympathetic system or /and promotes Natriuretic system. Other drugs increase ventricular contractility orreduceretention which is amajorsymptom ofheart failure. In the united state , a large proportion of people have hypertension, obesity, diabetes and atherosclerotic cardiovascular disease. Therefore, a large proportion are at risk of heart failure or stage A heart failure. The most common causes of HF include ischemic heart disease and myocardial infarction (MI) , hypertension and valvular heart disease (VHD) . other causes are familial orgenetic cardiomyopathies, Amyloidosis, substance abusesuch as alcohol, cocaine, or methamaphetamine, Tachycardia, right ventricular pacing or stress- induced cardiomyopathies, peripatum cardiomyopathy, chemotherapy- induced cardiotoxicity, Hemochromatosis , and thyroid disease. page433 INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE ISSN:2692-5206,ImpactFactor:12,23 AmericanAcademicpublishers,volume05,issue06,2025 Journal: https://www.academicpublishers.org/journals/index.php/ijai ACC/AHA ( American college of cardiology or American heart association ) both classified heart failure in 4 stages- Stage A - patients at risk for heart failure but without current or previous signs/symptoms of HF and without structural or functional heart disease or abnormal biomarkers . Stage B - pre heart failure , patients without current or previous symptoms/signs of heart failure but evidence of 1 of the following: structural heart disease, evidence of increased filling pressures , risk factors and increased natriuretic peptide levels or persistently elevated cardiac troponin in the absence of competing diagnosis. Stage C - symptomatic heart failure- patients with current or previous signs/symptoms of heart failure. Stage D - Advanced heart failure- marked HF symptoms that interfere with daily life and with recurrent hospitalization despite attempts to optimize GDMT. NYHA classification- it is independent predictor of mortality, and it is widely used in clinical practice to determine the eligibility of patients for treatment strategies. NYHA Class I - no symptoms with normal physical activity and normal function status. NYHA Class II- Mild symptoms with normal physical activity, comfortable at rest and slight limitation of functional status . NYHA Class III - Moderate symptoms with less than normal physical activity , comfortable only at rest and marked limitation of functional status. NYHA IV- severe symptoms with features of heart failure with minimal physical activity and even at rest and severe limitation of functional status .The new classification of heart failure primarily categorizes patients based on their left ventricular ejection fraction (LVEF), with three main groups: heart failure with reduced ejection fraction (HFrEF) for LVEF below 40%, heart failure with preserved ejection fraction (HFpEF) for LVEF above 50%, and heart failure with mildly reduced ejection fraction (HFmrEF) for LVEF between 41% and 49%. Recent research has introduced innovative pharmaceutical approach that hold promise for improving patients outcome. New drugs like Sodium -glucose co- transporter 2 (SGLT2) inhibito