Surviving heart failure: Robert L. Frye lecture.
Heart failure is increasing in both incidence and prevalence and is associated with a high mortality. In patients with heart failure, coronary artery disease is the cause for about two thirds. Pathophysiologic changes have been linked to altered muscle function and hemodynamics, elevated neurohormones, and, more recently, cellular mechanisms, including apoptosis. Standard triple therapy for symptomatic heart failure consists of an angiotensin-converting enzyme (ACE) inhibitor, digoxin, and a diuretic. In patients with severe heart failure, spironolactone should be added. In large clinical trials, ACE inhibitors, spironolactone, and beta-blockers have reduced mortality. Other drugs may be helpful in the treatment of heart failure. Amiodarone is the antiarrhythmic drug of choice in patients with symptomatic arrhythmias and also has a role in the treatment of dilated cardiomyopathy. Angiotensin II receptor blockers are being compared with ACE inhibitors and appear promising. Newer agents being tested include antagonists to endothelin and tumor necrosis factor. Overall, it is clear that polypharmacy is the standard of care for patients with heart failure. A future challenge will be to prevent heart failure from occurring.
Parmley
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University of California, San Francisco, USA.
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D018377:Neurotransmitter Agents / Q000097:blood
D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004232:Diuretics; D018377:Neurotransmitter Agents; D004077:Digoxin