Pharmacotherapy implications of revised chronic heart failure guidelines.
OBJECTIVE
To provide an overview of major drug therapy recommendations within recently revised chronic heart failure (CHF)guidelines.


METHODS
Guideline statements and English-language articles from MEDLINE pertinent to CHF.


METHODS
Recently published guidelines from the American College of Cardiology (ACC)/American Heart Association (AHA) and the Heart Failure Society of America (HFSA) served as the focus of this review. Prospective comparative trials, review articles, and editorials were also considered.


RESULTS
Recommendations within the ACC/AHA and HFSA guidelines continue to provide a systematic, evidence-based approach regarding CHF management. The HFSA guidelines recommend that the severity of clinical disease and functional limitation be characterized using the New York Heart association (NYHA) functional classification system. A key feature of the ACC/AHA guidelines is the use of a staging system that recognizes the development and progression of heart failure. Both guidelines stress the importance of neurohormonal blockade with angiotensin-converting enzyme inhibitors and beta-adrenergic blockers. Moreover, the guidelines expand the role of aldosterone antagonists, angiotensin II receptor blockers, and hydralazine/isosorbide dinitrate, particularly in combination with standard treatments. Diuretics and digoxin remain symptomatic treatments only.


CONCLUSIONS
This article summarizes key drug therapy recommendations from the revised ACC/AHA and HFSA guideline statements. Pharmacists caring for CHF patients should be familiar with these recommendations and aid in their implementation.
Crouch
Michael A
MA
Virginia Commonwealth University, Richmond, VA 23298-0533, USA. macrouch@vcu.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D017410:Practice Guidelines as Topic / Q000592:standards*; D012955:Societies, Medical / Q000458:organization & administration / Q000592:standards
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D006830:Hydralazine