Congestive heart failure - Therapeutic management

Towards optimal care: it is essential to distinguish between systolic and d iastolic dysfunction to achieve optimal management of patients with congest ive heart failure. Data is lacking in the literature for validation of the guidelines usually applied in the elderly population. A specific analysis o f therapeutic management of diastolic heart failure has never been performe d. Altered response to drugs and associated disease slates argue for an ass essment of therapeutic options. The therapeutic objectives to test are diff erent in the elderly population where quality of life and morbidity are mor e important than mortality criteria. In clinical practice, the empirical ap proach still predominates over evidence based medicine. Therapeutic goals: Al the acute phase, volume overload requires rapid actio n diuretics and a treatment of the triggering cause. For chronic situations , diet and lifestyle play a major role (reduced salt intake, regular exerci se). Drug therapy, particularly converting enzyme inhibitors have been foun d to be guile effective. Rehabilitation and secondary preventive measures a re the only validated methods proven to improve quality of life. (C) 1999, Masson, Paris.