Higher expectations for management of heart failure: current recommendations.
BACKGROUND
Some 4.6 million Americans are estimated to suffer from heart failure, and approximately 400,000 new cases are diagnosed each year. Each year 260,000 patients die as a direct or indirect result of the disorder, with annual costs estimated between $21 billion to $40 billion.


METHODS
The medical literature was searched using the key words "heart failure," "beta-adrenergic blockade," "angiotensin-converting enzyme inhibition," and "carvedilol." A case study illustrates the value of an emerging pharmacologic approach for some heart failure patients and places it in clinical perspective.


RESULTS
During the past decade, placebo-controlled clinical trials have shown decreased morbidity and mortality resulting from timely intervention using a targeted multidrug approach: first, diuresis; then angiotensin-converting enzyme inhibition and beta-adrenergic-receptor blockade, possibly with digoxin for symptomatic relief.


CONCLUSIONS
An emerging approach to therapy aims to reverse the course of left ventricular dysfunction and arrest the underlying disease process, as well as improve hemodynamic function. Management of heart failure has thus entered a new era of more effective pharmacotherapy, often delivered within the primary care setting.
Abraham
William T
WT
Division of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington, USA.
Scarpinato
Len
L
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011412:Propanolamines / Q000627:therapeutic use*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol