State of the art: current treatment of heart failure

Heart failure (HF) is associated with high morbidity and mortality. Mela-an alyses reveal that average mortality decreases from 35% to 25% with use of angiotensin-converting enzyme (ACE) inhibitors and from 25% to 15% when bet a-blockers are added to conventional therapy. The RALES trial has recently demonstrated that adding spironolactone to standard therapy can further red uce mortality in HF patients. These studies indicate that heart failure therapy is based on a threefold a pproach, namely ACE inhibitors (eventually in combination with angiotensin II antagonists), beta-blocker therapy and aldosterone antagonists. Digitali s may serve as an adjunct in symptomatic patients who do not respond adequa tely to ACE-inhibitors and diuretics. Digitalis helps to reduce progression of the disease and decreases the rate of hospitalizations. In patients wit h severely depressed systolic function (<30%), anticoagulation may be neces sary to prevent thromboembolic complications, especially in the presence of atrial fibrillation. Appropriate exercise training as well as adequate cal oric uptake may help to reduce deconditioning. (C) The European Society of Cardiology.