PMID- 1667716
OWN - NLM
STAT- MEDLINE
DCOM- 19920625
LR  - 20191028
IS  - 1042-9611 (Print)
IS  - 1042-9611 (Linking)
VI  - 25
IP  - 12
DP  - 1991 Dec
TI  - Changing strategies in the management of chronic congestive heart failure.
PG  - 1349-54
AB  - Recent studies have more clearly defined the role of drug therapy in patients 
      with chronic congestive heart failure (CHF). Treatment of patients with 
      asymptomatic left ventricular dysfunction (New York Heart Association [NYHA] 
      class I) cannot be recommended at this time. The benefit of prophylactic 
      treatment with angiotensin-converting enzyme inhibitors (ACEIs) or vasodilators 
      in patients at high risk for developing symptomatic CHF is currently being 
      evaluated. Treatment of patients with symptomatic CHF (NYHA class II-IV) should 
      be initiated with a combination of a diuretic, digoxin, and an ACEI. This 
      combination has been shown to reduce the mortality rate in patients with NYHA 
      class II-IV CHF. Patients who remain symptomatic despite treatment with this 
      combination may benefit from the addition of the direct-acting, nonspecific 
      vasodilators--hydralazine and a nitrate. The addition of the nonspecific 
      vasodilators to an ACEI has not been tested in controlled trials. In patients who 
      remain symptomatic despite treatment with diuretics, digoxin, ACEIs, and 
      nonspecific vasodilators, treatment options are not clear. The use of 
      beta-agonists, phosphodiesterase inhibitors, and intermittent fixed-dose, 
      fixed-interval dobutamine should be avoided as these agents are associated with a 
      high mortality rate. Heart transplantation should be considered early in the 
      course of CHF to allow for preservation of other vital organ systems. 
      Unfortunately, heart transplantation is available to only a very small minority 
      of potential transplant candidates.
FAU - Hilleman, D E
AU  - Hilleman DE
AD  - Creighton University Cardiac Center, Omaha, NE 68131.
FAU - Mohiuddin, S M
AU  - Mohiuddin SM
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - DICP
JT  - DICP : the annals of pharmacotherapy
JID - 8904338
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Diuretics)
RN  - 0 (Phosphodiesterase Inhibitors)
RN  - 0 (Receptors, Adrenergic, beta)
RN  - 3S12J47372 (Dobutamine)
RN  - 73K4184T59 (Digoxin)
SB  - IM
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Digoxin/therapeutic use
MH  - Diuretics/therapeutic use
MH  - Dobutamine/pharmacology
MH  - Drug Therapy, Combination
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Phosphodiesterase Inhibitors/pharmacology/therapeutic use
MH  - Receptors, Adrenergic, beta/drug effects
RF  - 38
EDAT- 1991/12/01 00:00
MHDA- 1991/12/01 00:01
CRDT- 1991/12/01 00:00
PHST- 1991/12/01 00:00 [pubmed]
PHST- 1991/12/01 00:01 [medline]
PHST- 1991/12/01 00:00 [entrez]
AID - 10.1177/106002809102501214 [doi]
PST - ppublish
SO  - DICP. 1991 Dec;25(12):1349-54. doi: 10.1177/106002809102501214.