Chronic heart failure - improving life with modern therapies

Chronic heart failure (CHF) is an increasingly common condition with increasing prevalence in the aging population. It has a significant mortality and is associated with a high incidence of hospitalisation and morbidity.

This article describes the aspects of modern therapy that can improve survival, reduce hospitalisation and improve quality of life for CHF patients.

A careful history, physical examination and judicious investigation (including chest X-ray, electrocardiogram, complete blood profile and echocardiogram) can often identify the cause of CHF, the severity of CHF and help guide management. Treatments which have been shown to be of significant benefit include angiotensin converting enzyme inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers. Loop diuretics, nitrates, digoxin, hydralazine and amiodarone may be used when patients do not respond to initial therapy. Review by a cardiologist is often useful to exclude myocardial ischaemia and to perform echocardiography which is a key investigation in assessment of CHF patients. Ongoing regular review with uptitration of medications to achieve target blood pressure and pulse and exclude exacerbating conditions can lead to improvements in care and facilitate successful outcomes in CHF patients who are often very unwell.