Practical issues in the treatment of patients with heart failure

The management of heart failure is complex. Initiating and maintaining drug therapy in patients with heart failure can be challenging. Many factors influence the heart failure syndrome and are important to account for when evaluating these patients. Concomitant diseases such as ischemic heart disease and hypertension may contribute to worsening heart failure, and treatment strategies addressing these conditions should be implemented in affected patients. Concomitant drugs also must be considered. The heart failure population is at risk for drug interactions, both pharmacokinetic and pharmacodynamic, because these patients often take many drugs at the same time. Proactively recognizing potential interactions and modifying a patient's regimen to minimize or avoid adverse effects are important. Many agents are contraindicated in heart failure; thus, avoiding such therapies may significantly affect a patient's outcome. The successful treatment of a patient with heart failure requires careful consideration of many factors, including other diseases, drugs, and social issues. Addressing these factors when treating patients translates into improved pharmaceutical care.