Community management of heart failure

OBJECTIVE To review therapies for treating patients with heart failure (HF) . QUALITY OF EVIDENCE Recommendations in this paper are mainly based on the r esults of randomized controlled trials. To a lesser extent, data from small er, more physiologic studies are included. Where appropriate, recommendatio ns are based on the results of a consensus conference. MAIN MESSAGE Although pharmacologic therapy is the main strategy for treati ng HF patients, general measures, such as counseling and advice about regul ar physical activity, are an important component of management. Use of angi otensin-converting enzyme inhibitors (ACE-I) is central to treating HF pati ents, because these agents decrease mortality and morbidity significantly. Digoxin does not reduce mortality but does reduce morbidity. Angiotensin II antagonists, although found to provide clinical benefit equal to ACE-I, ha ve not been found as yet to have similar effects on mortality and morbidity . Diuretics and nitrates are useful for treating these patients' symptoms. Calcium channel blockers should generally be avoided. CONCLUSIONS Angiotensin-converting enzyme inhibitors are the therapy of cho ice for HF patients and should be used in all cases unless there are contra indications or clear evidence of intolerance. All other therapies are used mainly for symptom relief.