[Evidence based medical treatment of heart failure].
OBJECTIVE
Recommendations for the treatment of heart failure were carried out by a systematic review of the available evidence of the different pharmacologic treatments.


METHODS
The review focused on the treatment of chronic and systolic heart failure. All the studies published in english about the pharmacologic treatment of heart failure where identified. The evidence of every pharmacologic treatment was classified according to: a) efficacy variables (reduction of mortality and hospitalizations, improvement of functional class, ejection fraction and exercise tolerance), and b) the level of quality of the evidence according to an evaluation scale. The evidence was also reviewed for the comparisons and the combinations of the pharmacologic treatments, as well as for the toxicity and costs of treatments.


RESULTS
The recommendations were defined according to the NYHA functional class and were classified in the A, B and C categories according to the level of quality of the available evidence. The evidence on mortality was considered the most important. First line drugs, the alternatives and other possible treatments were take into account.


CONCLUSIONS
There is enough evidence based on information about some variables such as reduction of mortality or hospitalizations to carry out treatment recommendations in all stages of heart failure. This point out the interest ant the priority of used them in the evaluation and improvement of the results of heart failure.
Agustí Escasany
A
A
Fundación Institut Català de Farmacologia. Servicios de Farmacología Clínica, Barcelona. ag@icf.uab.es
Durán Dalmau
M
M
Arnau De Bolós
J M
JM
Rodríguez Cumplido
D
D
Diogène Fadini
E
E
Casas Rodríguez
J
J
Galve Basilio
E
E
Manito Lorite
N
N
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D013148:Spironolactone / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D002316:Cardiotonic Agents; D004232:Diuretics; D014665:Vasodilator Agents; D013148:Spironolactone; D004077:Digoxin