Year: 1999
Type: editorial
Abstract: Heart Failure Therapy: Not as Complicated as It Looks One of our colleagues reported in last month's cardiology teaching session on the results of another major clinical trial in heart failure patients.Despite interesting and positive results, our associates greeted the presentation with a chorus of groans.(We're pretty outspoken here.)We understand the issue: state of the art heart failure treatment has become a complicated business.We have extensive guidelines, complicated drug therapy, and a number of new agents.We are not surprised that many doctors yearn for the simplicity of "bedrest, digitalis, and diuretics."In fact, as "heart failure-ologists" we may engage in a bit of self-aggrandizement when we push for statu.5 as a separate clinical section, have our own meetings, and publish in our own journals.Still, we have learned that the detinition of heart failure is broad and elusive; patients with heart failure are a heterogeneous lot; comorbidities are common and polyphannacy for these individuals is the rule rather than the exception.Despite the fact that most clinical trials of heart failure therapy do not accurately reflect the spectrum of disease in the community, we have learned a great deal about how to use the multiple drugs available today effectively.The current therapy of heart failure still fits into some simple rules, and expanding from the old three (rest, digitalis, and diuretics) to the current five should not tax most clinicians unduly.So what are the five new basics.and what do they mean for practitioners?Basic number one is neurohormonal blockade.The major improvement in heart failure therapy today has been the recognition that blocking the pathophysiologic activation of neurohumoral "compensatory" mechanisms, renin-angiotensin and sympathetic activation in particular, increases long-term survival.We have excellent drugs, including the angiotensin-converting enzyme inhibitors, angiotensin TI receptor blockers, aldosterone antagonists, and a variety of beta blockers.For most patients, the treating physician can choose drug therapy on the basis of cost and convenience.The most common problem we
Source: Clinical Cardiology
Authors: Roger M. Mills, James B. Young
Institution: Cleveland Clinic
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2039357788