Medical therapy in heart failure--is polypharmacy necessary?
The concept of heart failure has undergone several paradigm shifts in the past few decades. Therapeutic targets directed at the heart pump have shifted to circulatory haemodynamics to the current neurohormonal model. Consequently, therapeutic modalities have similarly evolved alongside clinical trials. Successive trials have tested newer drugs in addition to established therapies, resulting in evidence-based treatments necessitating polypharmacy. Optimal heart failure therapy has therefore become increasingly complex. It is only after understanding the precise modes of drug action, as well as the relevance of the design of clinical trials, will physicians hopefully be able to tailor the medical therapy optimally towards the individual patient with heart failure.
Kwok
B W K
BW
Department of Cardiology, National Heart Centre, 17 Third Hospital Avenue, Singapore 168752.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000465:Algorithms; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D019338:Polypharmacy; D011724:Pyridazines / Q000627:therapeutic use; D000077464:Simendan; D016277:Ventricular Function, Left
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D006835:Hydrazones; D000451:Mineralocorticoid Receptor Antagonists; D011724:Pyridazines; D000077464:Simendan