[Can pharmacotherapy in heart failure affect mortality?]

The prognosis of patients with advanced chronic cardiac failure is very poor. Only investigations made in recent years provided evidence that this adverse prognosis can be influenced by conservative pharmacological treatment. Among many tested vasodilating substances positive data were obtained only with high doses of nitrates with hydralazine and in particular with inhibitors of the angiotensin converting enzyme which are the greatest advance in the treatment of chronic cardiac failure. Preparations of this group mitigate the symptomatology, increase load tolerance and improve the prognosis. So far they are indicated above all in severe forms of cardiac failure, however, the possibility to use them also in milder forms and in patients with myocardial infarction is intensively investigated. The basis of pharmacological treatment remain diuretics. The position of digitalis in the treatment of cardiac failure is revised at present; in a major proportion of patients, in particular those with a preserved sinus rhythm, its administration is useless. A number of other positively inotropic substances was tested, catecholamines as well as phosphodiesterase inhibitors (amrinone, milrinone, xamoterol, enoximone). Contrary to acute failure, their effect in chronic failure is controversial, data on an improved prognosis are lacking and some investigations reveal an adverse trend. Almost half the patients with cardiac failure die from a sudden death and it would thus be logical to use antiarrhythmic drugs. Here, too, however, data on an improved diagnosis are lacking. The results of hitherto accomplished studies were rather disappointing, the investigation with the most promising antiarrhythmic agent--amiodarone--is still under way.