[Drug therapy of cardiac insufficiency: status 1995]

Congestive heart failure is a frequent disorder with an estimated prevalence of 0.4-2% in the general population. Despite recent advances in our understanding of the pathophysiology of this disorder and new developments in its treatment, the prognosis of heart failure remains poor. All patients with heart failure should undergo diagnostic evaluation to determine the type of cardiac dysfunction, establish its etiology and orient treatment. Angiotensin converting enzyme (ACE) inhibitors, diuretics and digoxin are the standard therapy for chronic congestive heart failure caused by systolic dysfunction. ACE inhibitors are indicated in all stages of heart failure, even in asymptomatic patients. Diuretics should be added in the presence of fluid retention. Digoxin remains an important component in the management of refractory symptoms and atrial fibrillation. Symptomatic improvement and reduced morbidity have been shown with all these drugs. However, improved survival has been documented for ACE inhibitors only. Currently, numerous drugs with different mechanisms of action are being evaluated in ongoing clinical trials. Promising results have been published, mainly with beta-receptor blockers and newer positive inotropic substances. Rapidly growing evidence from basic research will advance our understanding of heart failure and hopefully pave the way for new preventive and therapeutic strategies in the near future.