Despite major advances in prevention and medical therapy, heart failure (HF) remains associated with high morbidity and mortality, especially in older and frailer patients. Therefore, a complete, guideline-based treatment is essential, even in HF patients with conditions traditionally associated with a problematic initiation and escalation of the medical HF therapy, such as chronic kidney disease and arterial hypotension, as the potential adverse effects are overcome by the overall decrease of the absolute risk. Furthermore, since the latest data suggest that the benefit of a combined medical therapy (MRA, ARNI, SGLT2i, beta-blocker) may extend up to a LVEF of 65%, further trials on these subgroups of patients (HFmrEF, HFpEF) are needed to re-evaluate the guideline-directed medical therapy across the HF spectrum. In particular, the use of SGLT2i was recently extended to HFpEF patients, as evidenced by the DELIVER and EMPEROR-preserved trials. Moreover, the indication for other conservative treatments in HF patients, such as the intravenous iron supplementation, was accordingly strengthened in the latest guidelines. Finally, the possible implementation of newer substances, such as finerenone, in guideline-directed medical practice for HF is anticipated with great interest.

尽管预防和药物治疗取得了重大进展，心力衰竭（HF）仍然与高发病率和死亡率相关，特别是在老年和体弱的患者中。因此，完整的、基于指南的治疗是至关重要的，即使对于那些传统上与药物性心力衰竭治疗的开始和升级有问题有关的心力衰竭患者，如慢性肾病和动脉低血压，因为潜在的副作用可以通过以下方法克服：绝对风险总体下降。此外，由于最新数据表明联合药物治疗（MRA、ARNI、SGLT2i、β-受体阻滞剂）的益处可能高达 65% 的 LVEF，因此需要对这些患者亚组（HFmrEF、HFpEF）进行进一步试验重新评估整个 HF 频谱的指南指导的药物治疗。特别是，正如 DELIVER 和 EMPEROR 保留试验所证明的那样，SGLT2i 的使用最近已扩展到 HFpEF 患者。此外，最新指南也相应强化了心力衰竭患者其他保守治疗的指征，例如静脉补铁。最后，人们对在指南指导的心力衰竭医疗实践中可能实施新物质（例如 Finerenone）充满兴趣。