Chapter 13: Current Management and Treatment

The prevalence of heart failure (HF) is escalating rapidly, consuming significant healthcare resources, inflicts significant morbidity and mortality, and greatly impacts quality of life. Dilated cardiomyopathy (DCM) is a frequent cause of HF and is characterized by a progressive course. Nowadays pharmacological and non-pharmacological therapies have dramatically changed DCM’s natural history. Familial screening program represents the first step in order to identify preclinic manifestation of DCM: first-degree relatives carrying a disease-causing mutation or without a clear genetic background must perform a periodic clinical and instrumental evaluation. Patients with a clinical diagnosis of HF and LV dysfunction should receive recommended therapies: beta-blockers (BB), ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB), aldosterone antagonists, and more recently angiotensin receptor-neprilysin inhibitor (ARNI) and ivabradine are established therapies for chronic HF. In case of persistent systolic dysfunction and/or severe intraventricular conduction delay, an ICD and/or CRT are indicated. Finally, heart transplantation and mechanical circulatory support (MCS) are options that can be used in critically ill HF who can’t be stabilized by medical therapy alone.