[Drug treatment for chronic XXXX with reduced ejection fraction].

@entity1 @entity712 @entity1369 @entity1289 @entity955 @entity1482 @entity4144
Based on multiple randomized controlled trials performed in the last 20 years, drugs form the basis of treatment for @entity712 with reduced ejection fraction (HFREF). Despite solid evidence for their efficacy and safety and publication of detailed national and international guidelines many @entity1 with HFREF remain, who are not at all or only insufficiently treated. Treatment goals include reduction of mortality and hospitalizations, improvement of symptoms and exercise tolerance as well as prevention of disease progression. @entity1289 -inhibitors and beta-adrenergic receptor blockers exert beneficial effects on all treatment goals and are therefore indicated in all @entity1 with HFREF if tolerated. Diuretics allow control of fluid retention and maintenance of "euvolemia". Low-dose @entity1482 can be considered in persistent moderate to severe (NYHA 3 - 4) HFREF despite treatment. Angiotensin receptor blockers are indicated for @entity1289 -inhibitor intolerance or in addition to @entity1289 -inhibitors and beta-adrenergic receptor blockers in case of persistent symptoms. Triple combination of @entity1289 -inhibitors, angiotensin receptor blockers and @entity1369 antagonists should be avoided in view of the substantial risk of @entity4144 . In current praxis digoxin is mainly used as an adjunctive agent for rate control of @entity955 in combination with beta-adrenergic receptor blockers. Titration and maintenance of @entity712 treatment requires continuous control of clinical parameters, renal function and electrolytes. It is recommended to use drugs and dosest hat have been shown to be effective in clinial trials. Despite the fact that @entity712 is mainly a disease of the elderly, this population is underrepresented in clinical trials. The risk of side effects and drug-drug interactions is increased in elderly @entity1 because of physiologic changes with age and frequent comorbidities with resultant polypharmacy.
