Heart failure due to ischaemic heart disease: Epidemiology, pathophysiology and progression

Ischaemic heart disease is the most common underlying cause of heart failur e in industrialised countries. Its manifestations are protean with myocardi al infarction being only one important facet. The prognosis of patients wit h heart failure due to ischaemic heart disease also appears to be worse tha n that associated with many other aetiologies. The presence of ischaemic he art disease may influence both the efficacy and choice of treatment. Agents such as digoxin and amlodipine appear less effective in patients with isch aemic heart disease while ACE inhibitors and beta-blockers appear as or mor e effective in patients with ischaemic heart disease. Many have expressed a n opinion about how coronary disease should be managed in the patient with heart failure supported by little or no evidence. There are major theoretic al and practical concerns about the use of anti-coagulant, anti-platelet an d statin therapy in patients with heart failure as well as major theoretica l benefits. Only randomised controlled trials will resolve these issues. Th e same may be said of revascularisation. Fortunately trials addressing all these areas are under way. This should put the management of coronary disea se in patients with heart failure on a firm evidence-based footing.