Heart failure is a symptom complex of varied etiology associated with subst
antial mortality. Approximately 5 million Americans have the disease, with
400,000 new cases diagnosed each year. Despite better understanding of its
pathophysiology, therapeutic options remain suboptimal and the syndrome rem
ains associated with high rates of hospitalization and loss of economic pro
ductivity. Management traditionally included vasodilators, diuretics, and d
igoxin, with a focus on controlling symptoms and improving ejection fractio
n and exercise capacity. Drug therapy now is focused on improving survival,
with a reduction in health care costs related to hospitalizations. Drugs w
ith a proven benefit in reducing morbidity and mortality are angiotensin-co
nverting enzyme inhibitors, beta-blockers, and the combination of hydralazi
ne plus a nitrate. Diuretics, digoxin, dihydropyridine calcium channel bloc
kers, phosphodiesterase inhibitors, catecholamine infusions, amiodarone, le
ft ventricular assist devices, and transplantation are also options.