Document Detail


Pharmacologic therapy for patients with chronic heart failure and reduced systolic function: review of trials and practical considerations.
MedLine Citation:
PMID:  12729848     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Heart failure (HF) is a complex clinical syndrome resulting from any structural or functional cardiac disorder impairing the ability of the ventricles to fill with or eject blood. The approach to pharmacologic treatment has become a combined preventive and symptomatic management strategy. Ideally, treatment should be initiated in patients at risk, preventing disease progression. In patients who have progressed to symptomatic left ventricular dysfunction, certain therapies have been demonstrated to improve survival, decrease hospitalizations, and reduce symptoms. The mainstay therapies are angiotensin-converting enzyme (ACE) inhibitors and beta-blockers (bisoprolol, carvedilol, and metoprolol XL/CR), with diuretics to control fluid balance. In patients who cannot tolerate ACE inhibitors because of angioedema or severe cough, valsartan can be substituted. Valsartan should not be added in patients already taking an ACE inhibitor and a beta-blocker. Spironolactone is recommended in patients who have New York Heart Association (NYHA) class III to IV symptoms despite maximal therapies with ACE inhibitors, beta-blockers, diuretics, and digoxin. Low-dose digoxin, yielding a serum concentration <1 ng/mL can be added to improve symptoms and, possibly, mortality. The combination of hydralazine and isosorbide dinitrate might be useful in patients (especially in African Americans) who cannot tolerate ACE inhibitors or valsartan because of hypotension or renal dysfunction. Calcium antagonists, with the exception of amlodipine, oral or intravenous inotropes, and vasodilators, should be avoided in HF with reduced systolic function. Amiodarone should be used only if patients have a history of sudden death, or a history of ventricular fibrillation or sustained ventricular tachycardia, and should be used in conjunction with an implantable defibrillator [corrected]. Finally, anticoagulation is recommended only in patients who have concomitant atrial fibrillation or a previous history of cerebral or systemic emboli.
Authors:
Liviu Klein; Christopher M O'Connor; Wendy A Gattis; Manuela Zampino; Leonardo de Luca; Antonio Vitarelli; Francesco Fedele; Mihai Gheorghiade
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The American journal of cardiology     Volume:  91     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-05     Completed Date:  2003-05-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18F-40F     Citation Subset:  AIM; IM    
Affiliation:
Advocate Illinois Masonic Medical Center, Chicago, Illinois 60607, USA. Liviu.Klein-MD@advocatehealth.com
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Cardiac Output, Low / drug therapy*
Cardiotonic Agents / therapeutic use
Clinical Trials as Topic
Diuretics / therapeutic use
Heart Failure / drug therapy*
Humans
Hydralazine / therapeutic use
Isosorbide Dinitrate / therapeutic use
Systole
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Cardiotonic Agents; 0/Diuretics; 0/Vasodilator Agents; 86-54-4/Hydralazine; 87-33-2/Isosorbide Dinitrate
Comments/Corrections
Erratum In:
Am J Cardiol. 2003 Dec 1;92(11):1378

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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