COMBINATION-DRUG THERAPY IN CHRONIC HEART-FAILURE - IS TREATMENT PARTOF THE PROBLEM IN HEART-FAILURE

Despite advances in medical treatment, the annual mortality associated with severe heart failure remains over 40%, and even In mild heart fa ilure the associated mortality is 40% over 4 years. Once it has been d emonstrated that the morbidity and mortality to heart failure can be a dequately addressed by combinations of drug therapy, then it is logica l to attempt to strip out redundant components of these therapeutic re gimes. In the meantime, however, combination therapy is required to co unter many of the pathophysiological facets of tile heart failure synd rome, including fluid retention, neuroendocrine activation, progressiv e ventricular dysfunction, and sudden cardiac death. Diuretics and ACE inhibitors are well-established drug treatments. Digoxin appears to l essen the rate of progression of heart failure without altering surviv al. New evidence suggests that beta-blockers may be useful additions t o the heart failure therapeutic armamentarium, although whether all be tablockers are equally effective remains to be established.