[Medical treatment of chronic heart insufficiency].
The treatment of chronic heart failure by alteration of systolic function has made remarkable progress over the past ten years; this progress has been linked to the results of large-scale clinical trials involving tens of thousands of patients. The medical approach to heart failure is therefore based on established clinical data. The therapeutic aims have been extended: not only should treatment relieve the symptoms of the disease, but also reduce the frequency of relapse and hospitalization, and prolong survival duration. At the onset of the third millennium, three therapeutic classes have emerged: conversion enzyme inhibitors, spironolactone, and beta-blockers, which although counter-indicated only a short while ago, now constitute the revolutionary aspect of the approach to treatment of chronic heart failure. In addition to drug therapy and as in the case of other chronic diseases, the significant role of patient awareness, i.e., the information and education that is made available to the individual regarding his or her illness, should also be taken into consideration. Regarding the latter aspect, the experience gained in this field by the care systems can be utilized. However, recent epidemiological data have shown that the advances made in the treatment of heart failure only concern a minority of patients; and that elderly subjects, women, and patients suffering from heart failure in spite of normal systolic function, which constitute the majority of cases, have not been considered in these trials.
Isnard
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Service de cardiologie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651, Paris, France.
D002908:Chronic Disease; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans