[Recent advances and limitations of medical treatment on heart failure]

Main part of the management of chronic heart failure is pharmaceutical therapy. In patients with chronic heart failure due to left ventricular systolic dysfunction, enhanced activation of neurohormonal systems including sympathetic nerve and renin-angiotensin-aldosterone system plays the most important role in its progression and poor prognosis. Therefore, principle of treatment of chronic heart failure is inhibition of the elevated neurohormonal activity. Angiotensin converting enzyme inhibitors and beta blockers are class I drugs of choice. In patients who can not tolerate angiotensin converting enzyme inhibitors, angiotensin II receptor blockers are used as replacement. In patients with severe heart failure [New York Heart Association (NYHA) class > III], aldosterone antagonists are added. Diuretics are also class I drug necessary for an improvement of symptoms of heart failure. Recently, implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) are implanted more frequently, because volume of evidence indicates benefits of these non-pharmacological treatments. In this paper, recent advance in medical therapy for patients with heart failure and its limitation is discussed.