Treatment of congestive heart failure - Guidelines for the primary care physician and the heart failure specialist

During the past 10 years, the philosophy of heart failure treatment has evo lved from symptom control to a combined prevention and symptom-management s trategy. Recent clinical trials have proved that early detection can delay progression. Treatment of asymptomatic left ventricular dysfunction is as i mportant as treatment of symptomatic disease. The purpose of this review is to simplify recent guidelines for pharmacological management of chronic sy stolic heart failure for the primary care physician and the heart failure s pecialist. Early recognition and prevention therapies, combined with lifest yle modification, are essential in the treatment of heart Failure. Therapy with angiotensin-converting enzyme inhibitors, beta -blockers, and diuretic s is now standard. Digoxin is added to improve clinical symptoms, especiall y in patients with atrial fibrillation. Aldosterone antagonists may be reco mmended in select patients with stable New York Heart Association class III or IV heart failure. If angiotensin-converting enzyme inhibitors are not t olerated, angiotensin receptor blockers, hydralazine hydrochloride, and iso sorbide dinitrate are recommended. The data on antiarrhythmic and anticoagu lation therapies are inconclusive.