Pharmacological treatment
The CONSENSUS trial investigated ‘enalapril’ more than 30 years ago; it was the first systematic evaluation of lowering the number of heart failure-associated deaths via pharmacological treatment [16]. Since then, various substances have proven effective. Postulating an annual mortality rate of 20% and a mean survival time of 4.1 years at baseline, adding an angiotensin-converting enzyme inhibitor, beta-blocker, aldosterone antagonist and an implantable cardioverter-defibrillator (ICD) decreases annual mortality by 70% and lengthens the mean survival time by 5.6 years [17]. Results from the recently published PARADIGM-HF [Prospective Comparison of ARNI (Angiotensin Receptor–Neprilysin Inhibitor) with ACEI (Angiotensin-Converting–Enzyme Inhibitor) to Determine Impact on Global Mortality and Morbidity in Heart Failure] trial demonstrated an improvement in the mortality rate in response to applying new pharmacological treatment options. Sacubitril-valsartan proved superior in reducing the risks of death and hospitalization for heart failure compared to standard medical treatment by interacting with the neurohumoral system [18].