Chronic heart failure: contemporary diagnosis and management.
Chronic heart failure (CHF) remains the only cardiovascular disease with an increasing hospitalization burden and an ongoing drain on health care expenditures. The prevalence of CHF increases with advancing life span, with diastolic heart failure predominating in the elderly population. Primary prevention of coronary artery disease and risk factor management via aggressive blood pressure control are central in preventing new occurrences of left ventricular dysfunction. Optimal therapy for CHF involves identification and correction of potentially reversible precipitants, target-dose titration of medical therapy, and management of hospitalizations for decompensation. The etiological phenotype, absolute decrease in left ventricular ejection fraction and a widening of QRS duration on electrocardiography, is commonly used to identify patients at increased risk of progression of heart failure and sudden death who may benefit from prophylactic implantable cardioverter-defibrillator placement with or without cardiac resynchronization therapy. Patients who transition to advanced stages of disease despite optimal traditional medical and device therapy may be candidates for hemodynamically directed approaches such as a left ventricular assist device; in selected cases, listing for cardiac transplant may be warranted.
Ramani
Gautam V
GV
University of Maryland School of Medicine, Baltimore, USA.
Uber
Patricia A
PA
Mehra
Mandeep R
MR
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D017147:Defibrillators, Implantable; D005102:Health Expenditures / Q000639:trends; D006333:Heart Failure / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008403:Mass Screening; D015995:Prevalence; D011322:Primary Prevention; D011379:Prognosis; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D002316:Cardiotonic Agents; D014665:Vasodilator Agents