New approaches in the management of patients with chronic congestive heartfailure

The cost of caring for a growing number of patients with congestive heart f ailure is a staggering economic burden. Fortunately, an increasing number o f evidence-based guidelines have been developed which, if implemented, have the potential to save lives and money. In addition, there are newer unders tandings about the potential of current therapies, both medical and surgica l, to prevent the progression of disease. The foundation of diuretics, ACE inhibitors and beta-blockers serves to improve symptoms, decrease hospitali zations and improve survival. The roles of angiotensin receptor antagonists and cytokine antagonists are currently being clarified. The potential for myocardial recovery during left ventricular assist implantation has paved t he way for some exciting surgical procedures. The challenge in the future w ill be to develop an approach to the patient with heart failure which takes advantage of this new knowledge while avoiding a bewildering array of cost ly drugs which may not all be necessary at all stages of the disease. (C) 1 999 Prous Science. All rights reserved.