Heart failure: drug therapy in the nineties and beyond

The lesson learned from recent advances in the understanding of congestive heart failure is that it is too complex a process to be managed in a simple fashion. At present, incremental improvement such as that provided by ACE inhibitors, and now possibly by new agents such as flosequinan, are what we have to offer our patients, short of transplantation, to control symptoms and increase exercise tolerance. No one knows what the future holds for these patients, but one can hope that the current therapy and those drugs being studied in clinical trials will provide agents that will continue to reduce the morbidity and mortality associated with current therapies. However, only so much can be done with drugs in the failing heart, and research must continue in the area of cardiac transplantation as well as in the area of totally implantable ventricular assist devices.