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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Heart failure is a complex clinical syndrome. The pharmacological therapy for chronic heart failure has been changing in the past decade with acquired knowledge of the pathophysiology of this medical condition. Primary care physicians currently treat a significant number of patients. This article summarizes core topics of heart failure including epidemiological information, etiology, pathophysiology, clinical features and diagnostic tools. Also, we review some of the most relevant research studies that have led to the current recommendations for the pharmacological therapeutic strategies in the management of chronic heart failure. We make reference to the latest guidelines in the management of chronic heart failure submitted by the American College of Cardiology and the American Heart Association (ACC/AHA). New technological advances, such as the biventricular-pacing devices, are an important adjuvant to the established pharmacological therapies for chronic heart failure.
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PMID:Chronic heart failure: a review for the primary care physician. 1500 64

My patient, 65, has been classified as being in ACC/AHA Stage B heart failure, but she denies any history of heart failure. What does this new terminology mean?
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PMID:How to classify heart failure. 1530 7

beta-Adrenoceptor antagonists (beta-blockers) provide multiple benefits to patients with coronary artery disease. The 2001 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for secondary prevention of myocardial infarction (MI) recommend initiating beta-adrenoceptor blockade in all post-MI patients and continuing therapy indefinitely. Atenolol and metoprolol have been shown to decrease vascular mortality in the acute-MI period. In the post-MI period timolol provided a 39% reduction in mortality in the Norwegian Multicenter Study group and propranolol was associated with a 26% reduction in mortality in BHAT (Beta-blocker Heart Attack Trial). beta-Adrenoceptor antagonist therapy results in reduction of myocardial oxygen demand and is therefore also effective for the treatment of angina pectoris. In CAST (Cardiac Arrhythmia Suppression Trial) beta-adrenoceptor antagonist therapy was associated with a significant reduction in arrhythmic death or cardiac arrest. In the post-MI amiodarone trials EMIAT (European Myocardial Infarct Amiodarone Trial) and CAMIAT (Canadian Amiodarone Myocardial Infarction Trial) there was a mortality benefit and decreased arrhythmic death in patients who received both amiodarone and beta-adrenoceptor antagonist therapy, compared with patients receiving amiodarone therapy alone. In the post-MI defibrillator (implantable cardioverter defibrillator [ICD]) trials, AVID (Antiarrhythmic Versus Implantable Defibrillator) and MUSTT (Multicenter Unsustained Tachycardia Trial), beta-adrenoceptor antagonist therapy was independently associated with improved overall survival. The exception was the ICD patients in MUSTT, and the benefit was attenuated in the amiodarone and ICD patients in AVID.AHA/ACC guidelines recommend the use of beta-adrenoceptor antagonists in all patients with symptomatic left ventricular dysfunction, based on several large, controlled heart failure trials. Extended-release metoprolol succinate reduced all-cause mortality by 34% in MERIT-HF (Metoprolol Controlled-Release/Extended-Release Randomized Intervention Trial in Heart Failure). Bisoprolol was associated with a 34% mortality benefit in CIBIS-II (Cardiac Insufficiency Bisoprolol Study II) and carvedilol was associated with a 35% mortality reduction in the COPERNICUS (Carvedilol Prospective Randomized Cumulative Survival) trial. beta-Adrenoceptor antagonists reduce perioperative mortality in patients undergoing cardiac as well as non-cardiac surgery; however, they remain underutilised. Contraindications to beta-adrenoceptor antagonist therapy include severe bradycardia, high-grade atrioventricular block, marked sinus node dysfunction and acute exacerbations of heart failure. Many of the perceived adverse effects of beta-adrenoceptor antagonists have not been substantiated by large clinical trials.beta-Adrenoceptor antagonists differ with regard to receptor selectivity, receptor affinity, lipophilicity and intrinsic sympathomimetic activity. Beneficial properties of beta-adrenoceptor antagonists may not always be extrapolated as a class effect, and patient selection and drug preparations should follow trial guidelines. The beneficial effects of beta-adrenoceptor antagonists are clearly proven in cardiac patients and those at risk for cardiac disease. They are indicated for heart failure and proven beneficial in patients undergoing cardiac and non-cardiac surgery. These benefits appear to be consistent across most patient subgroups. beta-Adrenoceptor antagonists are generally well tolerated, yet significant morbidity and mortality result from their continued underutilisation.
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PMID:Optimising the use of beta-adrenoceptor antagonists in coronary artery disease. 1581 91

The role of aldosterone-antagonists in the treatment of congestive heart failure. Despite the advances of the treatment of congestive heart failure, nearly half of the patients diagnosed with this disease five years ago are alive today. Experimental and human studies have demonstrated, that under special pathologic condition, the heart extracts aldosterone, and aldosterone extraction in the heart stimulates increased collagen turnover culminating in ventricular remodeling. Aldosterone blockade has been shown to be effective in reducing total mortality and hospitalization for heart failure in patients with systolic left ventricular dysfunction due to chronic heart failure (RALES study with spironolactone) and in patients with systolic left ventricular dysfunction post acute myocardial infarction (EPHESUS study with eplerenone). These clinical studies have shown that mineralocorticoid receptor activation remains important despite the use of angiotensin converting enzyme inhibitor or angiotensin receptor blocking agent and a beta blocker. In the ACC/AHA (and in the European and Hungarian) guidelines for the evolution and management of chronic heart failure, the indication of spironolactone was defined of Class Ila, Level of Evidence: B in CHF of stage C. The eplerenone (in US: INSPRA) was approved for the management of CHF patients after myocardial infarction with ejection fraction < 40%. Eplerenone, compared with spironolactone, is associated with a lower incidence of gynecomastia and other sex hormone-related adverse effect (breast pain, menstrual abnormalities). The spironolactone should not be used in patients with a creatinine above 220 mikromol/l. Despite the guidelines recommendation, spironolactone has been widely used in patients without consideration of their functional class or ejection fraction, without optimization of background treatment with ACE inhibitors and beta-blockers.
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PMID:[The role of aldosterone-antagonists in the treatment of congestive heart failure]. 1588 38

The incidence of heart failure is increasing and its prevalence is high, ranging from 1% to 2% in middle aged patients to more than 10% in older patients. Several pharmacologic approaches developed during the past 15 years, have had at least in clinical trials a significant impact on progression of heart failure mortality. The effect of ACE-inhibitors has been documented extensively during the last 15 years. They offered 15% decrease in hospitalization for moderate heart failure and, depending on the severity of the disease, produced a 16% to 31% reduction in mortality. Angiotensin receptor blockers provide unique pharmacological mechanism, and have demonstrated high tolerability in large trials. According to the new ACC/AHA guidelines for the evaluation and management of heart failure, the results of evidence based studies using ACE-inhibitor and angiotensin blocker therapies were analyzed by the author.
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PMID:[The role of ACE inhibitors and angiotensin receptor blockers in the treatment and prevention of chronic heart failure]. 1592 27

Left ventricular systolic dysfunction (LVSD) and clinical heart failure are common complications of acute myocardial infarction (AMI) and result in substantially increased mortality and morbidity. Evidence-based cardiovascular protective therapies, including angiotensin-converting enzyme inhibitors, beta blockers, antiplatelet agents, and lipid-lowering medications, improve outcomes for these patients. However, this population is significantly undertreated with these guideline-recommended agents. Critical pathways have been demonstrated to improve the quality and consistency of treatment; as such, the new American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients with ST-elevation myocardial infarction (STEMI) recommend that critical pathways be implemented for the management of these patients. The recent Eplerenone Post-acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) demonstrates that eplerenone, a selective aldosterone blocker, has incremental benefit in decreasing mortality and morbidity when used with standard care therapies in patients post AMI with heart failure and LVSD. The clinical trial evidence coupled with the national guidelines provides a strong rationale for routine incorporation of aldosterone blockade into new or already established critical pathways for AMI complicated by LVSD and heart failure.
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PMID:Hospital protocols and evidence-based therapies: the importance of integrating aldosterone blockade into the management of patients with post-acute myocardial infarction heart failure. 1647 70

Chronic heart failure (CHF) in the elderly is a significant healthcare problem. Nearly half of CHF in this age group is diastolic heart failure with preserved left ventricular ejection fraction. However there is the limitation of the evidence-based therapy for this important group of patients. In this article, the treatments for the diastolic heart failure recommended in the ACC/AHA guidelines for the CHF (1998, 2001, 2005 versions) are described and common problems regarding the diagnosis and management of CHF in the elderly is also discussed. Furthermore, the recent topics about the treatment of diastolic heart failure are presented.
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PMID:[Characteristics of the chronic heart failure in the elderly]. 1668 84

This is the second of a two-part series on strategies for optimizing the delivery of cardiac resynchronization therapy (CRT). A previous article presented strategies to optimize CRT device functioning. This article focuses on patient-related aspects. The 2005 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Managing Adults with Chronic Heart Failure now designate CRT as a class IA recommendation for stage C patients (QRS duration, > or = 120 milliseconds; left ventricular ejection fraction, < or = 35%) who remain symptomatic despite optimal medical therapy. While the evidence from prospective randomized controlled trials demonstrates consistent and concordant support for CRT in patients with symptomatic heart failure and ventricular dyssynchrony, a substantial minority of patients do not experience clinical improvement from CRT. In addition to device optimization, optimizing individual patient responses is essential. This article discusses measures for enhancing the patient's response to a CRT device.
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PMID:Cardiac resynchronization therapy: a practical guide for patient management after device implantation, part II. 1689 81

Several pivotal clinical trials have generated new knowledge regarding drug therapy for heart failure. Thus, the Heart Failure Society of America (HFSA) and the American College of Cardiology-American Heart Association (ACC-AHA) guidelines were updated in 2006 and 2005, respectively. We review the evidence from these trials and summarize the changes to the HFSA and ACC-AHA guidelines. Based on data from these studies, the new guidelines include broader, stronger recommendations for beta-blocker therapy, and strong recommendations for angiotensin II receptor blockers. The aldosterone antagonists, spironolactone and eplerenone, are also included in the guidelines. Pharmacists should have a basic level of familiarity with the new guidelines on heart failure and the evidence from recent clinical studies. They should be able to relate how this information contributes to the evolving understanding of treatment strategies for heart failure.
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PMID:Current guidelines for treatment of heart failure: 2006 update. 1738 70

Congestive heart failure with preserved left ventricular systolic function has emerged as a growing epidemic medical syndrome in developed countries, which is characterized by high morbidity and mortality rates. Rapid and accurate diagnosis of this condition is essential for optimizing the therapeutic management. The diagnosis of congestive heart failure is challenging in patients presenting without obvious left ventricular systolic dysfunction and additional diagnostic information is most commonly required in this setting. Comprehensive Doppler echocardiography is the single most useful diagnostic test recommended by the ESC and ACC/AHA guidelines for assessing left ventricular ejection fraction and cardiac abnormalities in patients with suspected congestive heart failure, and non-invasively determined basal or exercise-induced pulmonary capillary hypertension is likely to become a hallmark of congestive heart failure in symptomatic patients with preserved left ventricular systolic function. The present review will focus on the current clinical applications of spectral tissue Doppler echocardiography used as a reliable noninvasive surrogate for left ventricular diastolic pressures at rest as well as during exercise in the diagnosis of heart failure with preserved left ventricular systolic function. Chronic congestive heart failure, a disease of exercise, and acute heart failure syndromes are characterized by specific pathophysiologic and diagnostic issues, and these two clinical presentations will be discussed separately.
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PMID:Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function. 1738 87


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