Therapy of heart failure.

Area of Science:

• Cardiology
• Pharmacology

Background:

• Heart failure incidence and prevalence are increasing, posing a significant healthcare burden.
• Chronic systolic heart failure involves decreased left ventricular function and cardiac output, activating compensatory neurohormonal systems.
• Long-term neurohormonal activation exacerbates cardiac dysfunction.

Purpose of the Study:

• To review the medical management of chronic systolic heart failure.
• To discuss treatments based on the underlying pathophysiology and their impact on mortality and morbidity.

Main Methods:

• Review of research studies and randomized clinical trials on heart failure treatment.
• Focus on pharmacological interventions targeting specific pathophysiological pathways.

Main Results:

• Hydralazine and nitrates were the first to show improved mortality and morbidity.
• Angiotensin-converting enzyme (ACE) inhibitors demonstrated greater improvements in mortality and morbidity.
• Beta-blockers, in combination with ACE inhibitors, provide additive benefits.
• Aldosterone antagonists, such as spironolactone, have recently shown decreased morbidity and mortality.
• Digoxin and diuretics improve symptoms and reduce hospitalizations but not mortality.

Conclusions:

• Pharmacological interventions targeting neurohormonal systems are crucial for managing chronic systolic heart failure.
• Sequential introduction of therapies like ACE inhibitors, beta-blockers, and aldosterone antagonists has revolutionized treatment outcomes.
• Further research continues to refine the medical management of heart failure.