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Therapy of Heart Failure with Reduced Ejection Fraction: What's New in the 2021 Guidelines? Abstract. The spectrum of treatment options for patients with heart failure with reduced ejection fraction (HFrEF) has substantially expanded over the last years. The 2021 guidelines of the European Society of Cardiology propose a new treatment algorithm for patients with HFrEF and define the role of the currently available drugs, interventions and devices in this context. The new standard is a basic therapy consisting of four drugs with different mechanisms of action for all patients with HFrEF: an angiotensin-converting enzyme inhibitor, a betablocker, a mineralocorticoid antagonist, and a sodium glucose co-transporter-2 inhibitor. Additional drugs and/or interventions/devices are indicated depending on the response to the four-drug basic therapy (which has to be up-titrated to the maximally tolerated doses) and the clinical phenotype. In the present article, we discuss the available drugs and devices, their role in the proposed HFrEF treatment algorithm and clinically relevant practical aspects.

Follow-up of Patients with Cardiac Pacemakers Abstract. General practitioners play a central role for patients with cardiac pacemakers (PM) because they are mostly the first medical professionals confronted with PM problems. Acute dyspnea, dizzy spells/fainting or infection of the device pocket are red flags in the first weeks after PM implantation and warrant urgent workup. Symptoms late after PM implantation are less overtly associated with the PM. Routine follow-up examinations include an inspection of the PM pocket and an ECG, which has to be interpreted with the knowledge of the PM function and PM programming. Frequently, a PM interrogation will be necessary to achieve a correct diagnosis and initiate the appropriate management.