PMID- 14770250
OWN - NLM
STAT- MEDLINE
DCOM- 20040308
LR  - 20071115
IS  - 0027-2507 (Print)
IS  - 0027-2507 (Linking)
VI  - 71
IP  - 1
DP  - 2004 Jan
TI  - A review of heart failure treatment.
PG  - 47-54
AB  - Heart failure is a common and costly medical condition. Ischemic heart disease 
      and hypertension account for most cases of heart failure in developed countries. 
      Estimates of the one-year mortality rates for patients with New York Heart 
      Association (NYHA) Class II, III, and IV are 10%, 20%, and 40%, respectively. 
      Angiotensin-converting enzyme (ACE) inhibitors reduce mortality of heart failure 
      patients by approximately 25% (odds ratio 0.77, 95% CI 0.67 0.88). Larger doses 
      of ACE inhibitors are more effective in preventing hospitalization than are lower 
      doses. Angiotensin II receptor blockers (ARBs) are an alternative for patients 
      who cannot tolerate ACE inhibitors because of their side effects (e.g., cough). 
      Evidence for benefits of using combination of ACE inhibitors and ARBs is 
      encouraging, but requires further study. For patients who cannot tolerate either 
      ACE inhibitors or ARBs, vasodilator therapy with hydralazine and nitrates will 
      probably provide benefit. (Diuretic therapy, while a mainstay of heart failure 
      treatment, is primarily used for symptom relief.) There is also evidence that 
      spironolactone reduces mortality (relative risk reduction 30%, 95% CI 18 40%) for 
      patients with NYHA class III and IV heart failure. When administering 
      spironolactone to heart failure patients, monitoring for hyperkalemia is 
      essential. After two centuries of use, randomized controlled trials have finally 
      demonstrated that digoxin is effective in preventing hospitalizations (relative 
      risk reduction 28%, 95% CI 21 34%). There is now overwhelming evidence that 
      beta-blockers are safe for heart failure patients but that they reduce the risk 
      of death for these patients by approximately 30%. In addition to these medical 
      interventions, heart failure patients may also benefit from a number of 
      non-pharmacological interventions.
FAU - Guyatt, Gordon H
AU  - Guyatt GH
AD  - Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
FAU - Devereaux, P J
AU  - Devereaux PJ
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Mt Sinai J Med
JT  - The Mount Sinai journal of medicine, New York
JID - 0241032
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Anti-Arrhythmia Agents)
RN  - 0 (Anticoagulants)
RN  - 0 (Diuretics)
RN  - 0 (Vasodilator Agents)
SB  - IM
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Anti-Arrhythmia Agents/therapeutic use
MH  - Anticoagulants/therapeutic use
MH  - Diuretics/therapeutic use
MH  - Heart Failure/drug therapy/mortality/surgery/*therapy
MH  - Humans
MH  - Prognosis
MH  - Randomized Controlled Trials as Topic
MH  - Vasodilator Agents/therapeutic use
RF  - 62
EDAT- 2004/02/11 05:00
MHDA- 2004/03/09 05:00
CRDT- 2004/02/11 05:00
PHST- 2004/02/11 05:00 [pubmed]
PHST- 2004/03/09 05:00 [medline]
PHST- 2004/02/11 05:00 [entrez]
PST - ppublish
SO  - Mt Sinai J Med. 2004 Jan;71(1):47-54.