DRUG-THERAPY OF CONGESTIVE-HEART-FAILURE - STATUS 1995

Congestive heart failure is a frequent disorder with an estimated prev alence of 0.4-2% in the general population. Despite recent advances in our understanding of the pathophysiology of this disorder and new dev elopments in its treatment, the prognosis of heart failure remains poo r. All patients with heart failure should undergo diagnostic evaluatio n to determine the type of cardiac dysfunction, establish its etiology and orient treatment. Angiotensin converting enzyme (ACE) inhibitors, diuretics and digoxin are the standard therapy for chronic congestive heart failure caused by systolic dysfunction. ACE inhibitors are indi cated in all stages of heart failure, even in asymptomatic patients. D iuretics should be added in the presence of fluid retention. Digoxin r emains an important component in the management of refractory symptoms and atrial fibrillation. Symptomatic improvement and reduced morbidit y have been shown with all these drugs. However, improved survival has been documented for ACE inhibitors only. Currently, numerous drugs wi th different mechanisms of action are being evaluated in ongoing clini cal trials. Promising results have been published, mainly with beta-re ceptor blocks and newer positive inotropic substances. Rapidly growing evidence from basic research will advance our understanding of heart failure and hopefully pave the way for new preventive and therapeutic strategies in the near future.