DRUG-THERAPY OF CONGESTIVE-HEART-FAILURE

Improvement of symptoms and, accordingly, quality of life, as well as prolongation of life, are the objectives of drug therapy in congestive heart failure patients. Diuretics are most effective in relieving sym ptoms related to congestion, and angiotensin converting enzyme inhibit ors improve exercise capacity, reduce the incidence of decompensations and hence hospitalizations, and prolong life. Angiotensin type-1 rece ptor antagonists also seem to improve survival, while digoxin improves symptoms and morbidity but not survival in patients in sinus rhythm. The value of prophylactic antiarrhythmic therapy with amiodarone and o ral anticoagulation in the presence of sinus rhythm is not established , and the role of newer dihydropyridine calcium antagonists and betabl ockers is also not precisely defined. These agents should only be cons idered in selected cases after careful consideration of potential adva ntages and risks, and should usually be used as an addition to establi shed therapy. Better understanding of the pathophysiology of congestiv e heart failure will lead to the development of new treatment concepts , the clinical relevance of which will have,to be tested in appropriat ely designed clinical trials.