[Current treatments of congestive heart failure]

Mortality in patients with congestive heart failure has been assessed in several large scale multicentric studies, confirming the therapeutic effect of certain treatments and raising questions as to the efficacy of other, sometimes new propositions. Conversion enzyme inhibitors are currently considered to be the first line treatment for heart failure because of their beneficial effect on mortality figures and their capacity to prevent aggravation. These drugs should always be prescribed for patients without contraindications, together with diuretics when signs of congestion develop, and digitalis in case of non-response, then finally nitroglycerin. Debate is still open on the effect of beta-blockers and amiodarone which should be reserved for use by specialists since it has not been definitely proven that they can lengthen survival time. Certain other drugs have given disappointing results compared with early expectations: direct vasodilators, positive inotrops (with the possible exception of vesnarinone), and class Ic antiarrhythmics. Finally several drugs in the development or research stage may prove to be effective in improving heart function, intermediary criteria and, most importantly, survival.