[Therapy of heart failure with ACE inhibitors--"evidence-based medicine" and clinical reality].
Treatment of patients with chronic heart failure improves symptoms and NYHA functional class in about 50-80% of all patients treated. A 15% reduction can be observed in the need for hospitalisation and a 16-31% reduction in 1-year mortality. 37% risk reduction for progression to symptomatic heart failure can be achieved with ACE-inhibition in asymptomatic patients with systolic left ventricular dysfunction (55). Thus, ACE-inhibition should be part of standard treatment in symptomatic and asymptomatic patients with left ventricular dysfunction. In symptomatic patients with chronic heart failure, combination therapy of an ACE-inhibitor with digitalis and diuretics is state of the art and improves symptoms significantly. The addition of a vasodilatator can be considered in selected cases. Based on recently published data on beta-adrenoreceptor-blockade in the treatment of chronic heart failure, beta-blockers seem to get part of standard therapy of heart failure in the present and near future (2, 44, 50, 60). In spite of innovations of modern heart failure therapy prognosis is still bad. Survival after diagnosis of severe heart failure (functional class NYHA III and IV) is limited to a mean of 14 month.
Auer
J
J
II. Internen Abteilung mit Kardiologie des a. ö. Krankenhauses der Barmherzigen Schwestern vom HI, Kreuz, Wels. johann.auer@khwels.at
Berent
R
R
Kirchgatterer
A
A
Weber
T
T
Mayr
H
H
Maurer
E
E
Eber
B
B
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000401:mortality
D000806:Angiotensin-Converting Enzyme Inhibitors