Clinical and pharmacologic management of chronic heart failure associated with left ventricular systolic dysfunction

Despite many recent advances, heart failure continues to be a major cause of morbidity and mortality in the United States. Once a patient is identified and evaluated as having heart failure, nonpharmacologic therapies such as a dietary restrictions, lifestyle changes, exercise strategies, and patient education are initiated as well as pharmacologic therapy. Angiotensin-converting-enzyme inhibitors, diuretics, and digoxin all are considered traditional therapy in the management of chronic heart failure associated with left ventricular systolic dysfunction. The role of newer therapies such as beta-blockers and angiotensin II receptor antagonists in the treatment of heart failure is in the process of being defined. Furthermore, new data is appearing concerning calcium channel blockers, spironolactone, and combinations of the various agents. Appropriate use of the traditional agents accompanied by a through understanding of the newer therapies and their roles is essential to the continued reduction of the morbidity and mortality associated with heart failure.