Overview: old and new controversies in the treatment of advanced congestive heart failure.
In 2001, patients with decompensated congestive heart failure can be treated with various intravenous inotropic agents, vasodilator agents, invasive hemodynamic monitoring, ventricular assist devices, and cardiac transplantation. The use of many of these agents is limited by toxicities and potentially incremental costs associated with intensive care unit stays. As new pharmacologic therapies become available, such as beta-blockers and natriuretic peptides, the combinatorial use of agents for the treatment of patients with decompensated heart failure presents new opportunities with potentially reduced toxicities. Finally, given the natural history of patients with advanced heart failure, it behooves all caregivers to understand the wishes and preferences of the patients who face life-threatening decompensation. This is particularly true with long-term intravenous inotropic therapy. This review article addresses some of the issues that can affect the balance between efficacy, toxicity, and patient preferences for end-of-life care.
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Department of Medicine and Heart Failure, University of Pennsylvania Health System, Philadelphia, PA, USA.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents; D009320:Atrial Natriuretic Factor