Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society.

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021-2022 in relation to Polish healthcare conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include drugs blocking the renin-angiotensin-aldosterone system, preferably angiotensin receptor antagonist/neprilysin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect - options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers - carvedilol and nebivolol), mineralocorticoid receptor antagonist, and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness has been confirmed in numerous prospective randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or the presence of arrhythmias. This article emphasizes the cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction value. We propose practical guidelines for the use of medicines, profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation, or antiplatelet and anticoagulant therapy are also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan, or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF are discussed.

Usefulness of Soft Tissue Therapy in Patients with Shoulder Pain Syndrome.

BACKGROUND: Shoulder pain is among the most common musculoskeletal pain syndromes. This study aimed to compare the effectiveness of the worldwide renowned Kaltenborn and Evjenth manual therapy and the innovative concept of Fascial Distortion Model (FDM) in the treatment of patients suffering from shoulder pain. MATERIAL AND METHOD: The study group consisted of 100 patients treated for shoulder pain (SP), who were randomly assigned to two groups: Group A, whose therapy involved FDM (51), and Group B, treated with Kaltenborn and Evjenth method (49). Exclusion criteria comprised age < 30 years, low threshold of sensitivity to pain, participation in another rehabilitation programme, uncontrolled arterial hypertension, neurological conditions associated with sensory impairment, connective tissue conditions and presence of 'red flags'. The tools used in the study included a digital inclinometer to measure the range of joint mobility and a NeuroTrack device to assess neuromuscular conductivity. Statistical analysis used the non-parametric Mann-Whitney U test and non-parametric Wilcoxon signed rank test. The significance threshold was accepted as p ≤ 0.05. RESULTS: Both groups showed significant improvement (p<0.05) in the range of motion in the upper limb in all direc-tions (flexion, abduction and external rotation) and change in the function of the infraspinous muscle. The only significant difference between the groups was found for external rotation (p<0.05), with Group A displaying a superior range of motion. CONCLUSIONS: 1. A single session of the Kaltenborn and Evjenth method and FDM in patients suffering from shoulder pain may increase their range of motion in the shoulder as well as improve the function of the infraspinous muscle. 2. Cur-rently there is insufficient evidence to warrant stronger recommendation of one of the study therapies over the other. 3. There is a need for further prospective randomised studies involving larger groups of patients and assessing long-term effec-tiveness of the therapies.