PMID- 16548668
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20060420
LR  - 20191109
IS  - 0888-5109 (Print)
IS  - 0888-5109 (Linking)
VI  - 20
IP  - 9
DP  - 2005 Sep
TI  - Chronic heart failure: developments and perspectives.
PG  - 751-65
AB  - OBJECTIVE: To describe the clinical presentation, diagnosis, and contemporary 
      treatment of chronic heart failure (CHF) while emphasizing the important role of 
      the pharmacist. DATA SOURCES: English-language articles from MEDLINE pertinent to 
      CHF. STUDY SELECTION AND DATA EXTRACTION: All relevant publications addressing 
      CHF management were considered, including prospective comparative trials, 
      epidemiological studies, guideline statements, review articles, and editorials. 
      Particular focus occurred on the primary literature published after the release 
      of noted guidelines. The Heart Failure Society of America (HFSA), and the 
      European Society of Cardiology (ESC). DATA SYNTHESIS: Heart failure is a common 
      disorder, especially in the elderly. To determine appropriate pharmacotherapy, 
      one must establish the type of dysfunction (systolic versus diastolic) as well as 
      characterize the patient's disease state according to the New York Heart 
      Association (NYHA) functional classification system and from the American College 
      of Cardiology (ACC)/American Heart Association (AHA), stage of diseases. Although 
      most patients have systolic dysfunction ([ejection fraction] less than 40%), the 
      prevalence of diastolic dysfunction (a normal to elevated ejection fraction) is 
      rising and it accounts for at least one-third of all cases. Six drugs/drug 
      classes are contemporary treatments in systolic heart failure, depending on NYHA 
      functional class: angiotensin-converting-enzyme inhibitors, diuretics, 
      beta-blockers, aldosterone antagonists, angiotensin II receptor-blockers, and 
      digoxin. Clinicians should be aware that studies demonstrate all these drugs/drug 
      classes prolong survival in systolic heart failure, except diuretics and digoxin. 
      Some patients with systolic dysfunction also may be candidates for the 
      combination of hydralazine/isosorbide dinitrate as well as nonpharmacological 
      approaches with biventricular pacemakers and/or implantable cardioverter 
      defibrillators. Treatment of diastolic heart failure is less evidence-based, and 
      speculative treatments focus on control of blood pressure, tachycardia, volume 
      overload, and myocardial ischemia. CONCLUSIONS: CHF treatment remains a 
      therapeutic challenge. Pharmacists have an essential role in the care of these 
      patients by avoiding drugs known to exacerbate the disease, promoting optimal 
      pharmacotherapy, and ensuring compliance with prescribed drugs and dietary 
      modifications.
FAU - Crouch, Michael A
AU  - Crouch MA
AD  - Virginia Commonwealth University, Richmond, Virginia 23298-0533, USA. 
      macrouch@vcu.edu
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Consult Pharm
JT  - The Consultant pharmacist : the journal of the American Society of Consultant 
      Pharmacists
JID - 9013983
EDAT- 2006/03/22 09:00
MHDA- 2006/03/22 09:01
CRDT- 2006/03/22 09:00
PHST- 2006/03/22 09:00 [pubmed]
PHST- 2006/03/22 09:01 [medline]
PHST- 2006/03/22 09:00 [entrez]
AID - 10.4140/tcp.n.2005.751 [doi]
PST - ppublish
SO  - Consult Pharm. 2005 Sep;20(9):751-65. doi: 10.4140/tcp.n.2005.751.