PMID- 12729848
OWN - NLM
STAT- MEDLINE
DCOM- 20030523
LR  - 20190623
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 91
IP  - 9A
DP  - 2003 May 8
TI  - Pharmacologic therapy for patients with chronic heart failure and reduced 
      systolic function: review of trials and practical considerations.
PG  - 18F-40F
AB  - 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.
FAU - Klein, Liviu
AU  - Klein L
AD  - Advocate Illinois Masonic Medical Center, Chicago, Illinois 60607, USA. 
      Liviu.Klein-MD@advocatehealth.com
FAU - O'Connor, Christopher M
AU  - O'Connor CM
FAU - Gattis, Wendy A
AU  - Gattis WA
FAU - Zampino, Manuela
AU  - Zampino M
FAU - de Luca, Leonardo
AU  - de Luca L
FAU - Vitarelli, Antonio
AU  - Vitarelli A
FAU - Fedele, Francesco
AU  - Fedele F
FAU - Gheorghiade, Mihai
AU  - Gheorghiade M
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Cardiotonic Agents)
RN  - 0 (Diuretics)
RN  - 0 (Vasodilator Agents)
RN  - 26NAK24LS8 (Hydralazine)
RN  - IA7306519N (Isosorbide Dinitrate)
SB  - IM
EIN - Am J Cardiol. 2003 Dec 1;92(11):1378
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Cardiac Output, Low/*drug therapy
MH  - Cardiotonic Agents/therapeutic use
MH  - Clinical Trials as Topic
MH  - Diuretics/therapeutic use
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Hydralazine/therapeutic use
MH  - Isosorbide Dinitrate/therapeutic use
MH  - Systole
MH  - Vasodilator Agents/therapeutic use
RF  - 216
EDAT- 2003/05/06 05:00
MHDA- 2003/05/24 05:00
CRDT- 2003/05/06 05:00
PHST- 2003/05/06 05:00 [pubmed]
PHST- 2003/05/24 05:00 [medline]
PHST- 2003/05/06 05:00 [entrez]
AID - S0002914902033362 [pii]
AID - 10.1016/s0002-9149(02)03336-2 [doi]
PST - ppublish
SO  - Am J Cardiol. 2003 May 8;91(9A):18F-40F. doi: 10.1016/s0002-9149(02)03336-2.