The pharmacologic treatment of heart failure.
Congestive heart failure is common, affecting 4-5 million American's with more than 500,000 new cases each year. A number of therapies have been proposed for the treatment of CHF; some have been found useful and some not. Digoxin therapy long a mainstay of therapy has been found beneficial, but lower doses and caution with its use in women has been recently advised based on new information. Converting enzyme inhibitors and beta blockers both add benefit when used in combination. The addition of aldosterone antagonists to the digoxin, diuretic, ACE, and beta-blocker combination appears to offer benefit and the use of the new less toxic eplerone will become more frequently employed in selected patients. Sudden death is also an important contributor to mortality in CHF patients. Use of a amiodarone and ICD's have both been reported to offer benefit. Selecting the optimum cost effective therapy is a challenge to those treating heart failure patients. ICD's are recommended in class II, III CHF with EF < 30 and amiodarone may be the therapy of choice in selected class IV patients and in patients with EF > 30%.
Somberg
John C
JC
The Division of Clinical Pharmacology, Rush University, Chicago, Illinois 60044, USA. jsomberg@rush.edu
Molnar
Janos
J
D000367:Age Factors; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004232:Diuretics / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012737:Sex Factors
D002317:Cardiovascular Agents; D004232:Diuretics