"Nihilism" of chronic heart failure therapy in children and why effective therapy is withheld

European Journal of Pediatrics
Dietmar Schranz, Norbert F Voelkel

Abstract

Major advances in chronic heart failure (cHF) therapy have been achieved and documented in adult patients, while research regarding the mechanisms and therapy of cHF in children has lagged behind. Based on receptor physiological studies and pharmacological knowledge, treatment with specific ß1-adrenergic receptor blocker (ARB), tissue angiotensin-converting enzyme inhibitor (ACE-I), and mineralocorticoid antagonists have to be recommended in children despite lack of sufficient data derived from prospective randomized studies. At our institution, bisoprolol, lisinopril, and spironolactone have been firmly established to treat systolic cHF, hypoplastic left heart syndrome (HLHS) following hybrid approach and congenital left-right shunt diseases, latest in patients where surgery has to be delayed. Chronic therapy with long-acting diuretics and fluid restriction are not advocated because short-term effects are achieved at the expense of further neuro-humoral stimulation. It remains unclear why diuretics are recommended although evidence-based studies, documenting long-term benefit, are missing. However, that is true for all currently used drugs for pediatric cHF. This review focuses on the prevailing "nihilism" of cHF therapy in ch...Continue Reading

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Citations

Jul 12, 2018·Cardiology in the Young·Christian B Poulsen, Mads Damkjær
Feb 16, 2018·The New England Journal of Medicine·Antonino TuttolomondoAntonio Pinto
Aug 28, 2020·Hemodialysis International·Daljit K Hothi, Matthew Fenton
Feb 15, 2018·The New England Journal of Medicine·David H Ellison, G Michael Felker
Nov 27, 2020·Stem Cell Research & Therapy·Christoph HallerMichael A Laflamme
Mar 4, 2021·Seminars in Fetal & Neonatal Medicine·Koert de WaalMartin Kluckow
Mar 16, 2021·Asian Bioethics Review·Florencia Luna, Valerie A Luyckx
Jun 19, 2021·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Daljit K Hothi
Aug 1, 2021·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Marisa Gasparini, Natasha Cox

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Methods Mentioned

BETA
pharmacotherapy

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