Clinical Review Regular review

Drug treatment in heart failure

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7243.1188 (Published 29 April 2000) Cite this as: BMJ 2000;320:1188
  1. Eva Lonn, associate professor of medicine (lonnem@fhs.McMaster.ca),
  2. Robert McKelvie
  1. Hamilton Health Sciences Corporation, General Site, McMaster Clinic, Hamilton, Ontario L8L 2X2, Canada
  1. Correspondence to: E Lonn

    Heart failure represents a complex clinical syndrome characterised by abnormalities of left ventricular function and neurohormonal regulation, exercise intolerance, shortness of breath, fluid retention, and reduced longevity.1 Despite improvements in treatment the prognosis for patients with heart failure remains poor: the risk of death annually is 5%-10% in patients with mild symptoms and 30%-40% in those with advanced disease.2 3 This condition is also associated with major morbidity and healthcare expenditure, being responsible for about 5% of hospital admissions in the United Kingdom.4

    Box 1: Treatment of heart failure

    Aims

    • Relief of symptoms

    • Improvement in quality of life

    • Prevention of admissions to hospital, recurrent ischaemic events, and further deterioration in left ventricular function

    • Reduction in mortality

    Treatment modalities

    • Non-pharmacological treatments, such as exercise rehabilitation, dietary and psychological interventions, and patient education including self care strategies

    • Non-pharmacological treatments, such as exercise rehabilitation, dietary and psychological interventions, and patient education including self care strategies

    • Surgical and device based interventions

    Mitral valve surgery

    Coronary revascularisation

    Surgical ventricular remodelling procedures

    Cardiomyoplasty

    Dual chamber pacing

    Implantable cardioverter defibrillator treatment

    Ventricular assist devices

    Artificial heart

    Heart transplantation

    This review deals only with pharmacological treatments in chronic heart failure. Non-pharmacological measures apply to all patients, whereas surgical and device treatments (many still experimental) apply only to specific patient subsets. Patients with clinical symptoms of heart failure but normal or near normal left ventricular systolic function often have impaired left ventricular diastolic function. This heterogeneous group has been generally excluded from heart failure trials. We do not discuss the treatment of diastolic left ventricular dysfunction or acute heart failure syndromes: more comprehensive reviews are available.5

    Summary points

    The prognosis for patients with heart failure remains poor

    Drugs clearly shown to improve survival in patients with heart failure are ACE inhibitors and βblockers

    These drugs should be used in most patients with heart failure but require …

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