CONGESTIVE-HEART-FAILURE - TOWARDS A COMPREHENSIVE TREATMENT

Heart failure constitutes an increasing health hazard with major deman ds on health care resources. Recent major advances in drug treatment h ave yet to be translated into increased survival of heart failure pati ents in the community at large. Failure of diagnosis is a major factor in delaying early and adequate treatment. Echocardiography probably p rovides the most reliable and inexpensive instrument to confirm the di agnosis and pinpoint the mechanical components of the syndrome. The ta rgets for therapeutic intervention may be categorized (i) haemodynamic , neuroendocrine and metabolic disorders (ii) symptoms and quality of life, (iii) morbidity and mortality risks. Symptoms and quality of lif e are the prime concerns of the physician in the treatment in the indi vidual patient. Selection of anti-heart failure drugs used should be b ased on knowledge of the impact on the pathophysiological disorders an d on the morbidity and mortality risks. Diuretics, vasodilators and AC E-inhibitors are now accepted as standard treatment, particularly when used in combination. Controversy continues to surround the efficacy o f digitalis glycosides; they improve symptoms in some patients but the ir impact on morbidity and mortality risks is still uncertain. Even wi th standard treatments, may practical therapeutic questions remain, on e of which is what is the most efficacious dose of each anti-heart fai lure drug which, when used in combination, will give the maximum impro vement in quality of life and greatest extension of survival? Despite available treatment with diuretics, digitalis, vasodilators and ACE-in hibitors, the morbidity and mortality risks of congestive heart failur e remain high. None of these drug groups significantly modulates the e xcessive excitation of the sympathoadrenal system, one of the two majo r neuroendocrine hazards of heart failure. For this reason, amongst th e many newer drugs in development, the beta-adrenoceptor antagonists h old considerable promise as the next step towards a more comprehensive treatment of congestive heart failure.