Advances in the treatment of congestive heart failure: New approaches for an old disease

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.