Heart failure cases continue to drastically increase, and developing a better understanding of this pathophysiology with poor prognosis in patients and preliminary groups is an urgent issue. Numerous factors need to be incorporated by pharmacists for heart failure cases, including the establishment of favorable medication adherence, proposals for introducing standard pharmacotherapy [e.g., ACE (Angiotensin Converting Enzyme) inhibitors, ARB (Angiotensin Receptor Blocker), beta-blockers and MRA (Mineral corticoid Receptor Antagonist)], and prescription support for renal impairment cases. Furthermore, re-hospitalization rates among heart failure cases are high, which are caused by neglecting daily routines including poor medication adherence as well as infection in a majority of cases, so it is also extremely important to provide patient education on lifestyle aspects in coordination with other professions.
Suitable proposals of prescription for heart failure cases require the understanding of whether this was heart failure due to reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF). This is because the evidence relating to improved prognosis with pharmacotherapy of heart failure varies between the two conditions. In addition, prescriptions during exacerbated heart failure should propose the withdrawal of drugs which may possibly be related to worsening symptoms (e.g., NSAIDs). The introduction of medication for the treatment of heart failure should also pay attention to the possibility of worsening renal function due to ACE inhibitors, ARB and MRA, and bradycardia due to beta-blockers. Furthermore, appropriate countermeasures need to be proposed when diuretic resistance is present.