New evidence for improved survival in chronic heart failure

Abstract

Summary:Chronic heart failure is a common clinical syndrome with high associated mortality and morbidity. Recent advances in therapy for the condition with vasodilators and, in particular, angiotensin-converting enzyme inhibitors, have led to hopes for improvement in survival. Several large scale studies examining the role of vasodilators have reported over the la3t few years, and the role of vasodilators in the treatment and prevention of chronic heart failure is being delineated. There is new hope for patients with symptomatic heart failure; symptoms can be alleviated and prognosis improved. Increasingly, it appears as if there is a role for drug therapy in preventing the onset of chronic heart failure. In this paper, we examine the results of these studies and of some smaller studies in order to discuss the implications for current therapy and future research.derlying pathophysiologic mechanisms of chronic heart failure are not completely understood, but treatment has become available which improves the prognostic outlook. This paper reviews the recent large trials examining the role of vasodilation in the treatment of heart failure.Chronic heart failure is characterized by the activation of a number of neurohumoral mechanisms in response to reduced renal perfusion, notably the sympathetic5 and renin-angiotensin6.7 systems. At least partially in consequence of this, the peripheral vascular resistance is greatly elevated in chronic heart failure.8 Consequently, in recent years, a number of independent clinical trials has been conducted in order to assess the value of various vasodilating drugs in thls condition. The results of these studies demonstrate that the prognosis of even very Severe heart failure can be greatly improved, carrying considerable implications for patient management.

The Growing Healthcare Burden of CHF

“…19 Population studies have yet to show evidence of improved CHF prognosis (probably because more effective treatments are currently underused in the community), but this is likely to change in the near future. 20 Lifestyle trends can also contribute to increasing CHF, but the relationship is complex and indirect. Smoking, a potent cause of coronary artery disease is, for example, an independent and strong risk factor for CHF in men (although the findings in women are less consistent).…”

Evidence based optimization of medical therapy in Chronic Heart Failure

“…3 Modern treatments have improved the prognosis of heart failure. 4 Currently, the beneficial role of an electromechanical approach (pace maker) has been promoted as an effective adjunct therapy to optimum medical therapy in selected heart failure patients but not as an alternative. The purpose of this review is to evaluate the role of optimum pharmacological therapy in chronic heart failure patients.…”