[Treatment of heart failure: an update].
During the last years, the results of several trials on heart failure treatment were published or presented at international meetings. The new perspectives concern drug therapy and non-pharmacological strategies, such as cardioverter-defibrillators, biventricular resynchronization and implantable assist devices. Trials on beta-blockers extended the indication to patients with advanced heart failure, but the choice of the "best" beta-blocker to use remains an unsolved issue. Moreover, the concomitant use of ACE-inhibitors and angiotensin II receptor antagonists is a recent acquisition. However, the Val-HeFT results underscored that the add-on hypothesis of a more complete inhibition obtained with the combination of multiple agents was not confirmed in patients already taking ACE-inhibitors and beta-blockers. Regarding the new neurohormonal modulators (omapatrilat, etanercept, endothelin receptor blockers, arginine-vasopressin antagonists), more data are needed before using them in clinical practice. After the publication of the MADIT-II results, the cardioverter-defibrillator implantation will probably spread in patients with previous myocardial infarction and left ventricular dysfunction to prevent sudden death, but the cost-effectiveness ratio is still to be clarified. In the advanced or end-stage heart failure, when the improvement of quality of life represents the main target of therapy, ventricular resynchronization and implantable assist devices may play a role in clinical settings. Before considering them like a real therapeutic option, final results from ongoing investigations should be awaited.
Azienda Ospedaliera Ospedali Riuniti Piazza Ospedale, 1, 34100 Trieste. gianfranco.sinagra@aots.sanita.fvg.it
Gianfranco
G
Sinagra
Andrea
A
Perkan
Antonella
A
Cherubini
Luca
L
Salvatore
Andrea
A
Di Lenarda
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D065092:Antidiuretic Hormone Receptor Antagonists; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001552:Benzazepines / Q000627:therapeutic use; D000077300:Bosentan; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004311:Double-Blind Method; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008790:Metoprolol / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D010919:Placebos; D011412:Propanolamines / Q000627:therapeutic use; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013449:Sulfonamides / Q000627:therapeutic use; D013777:Tetrazoles / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D065092:Antidiuretic Hormone Receptor Antagonists; D000959:Antihypertensive Agents; D001552:Benzazepines; D002227:Carbazoles; D010919:Placebos; D011412:Propanolamines; D011725:Pyridines; D013449:Sulfonamides; D013777:Tetrazoles; D014665:Vasodilator Agents; D000077261:Carvedilol; C106389:conivaptan; C120582:tezosentan; D000068756:Valsartan; C024307:bucindolol; D008790:Metoprolol; D014633:Valine; D000077300:Bosentan