Clinical trials with implications regarding heart failure therapy

Paradigms for the treatment of heart failure have changed substantially over the past several decades. It has been the performance of relatively large, carefully controlled and often mortality endpoint trials that has given us great insight into therapies that are advantageous, disadvantageous, or neutral with respect to outcomes in patients with heart failure. No longer is the care of a patient with ventricular dysfunction and heart failure solely rooted in the prescription of a diuretic and digoxin. Indeed, we have seen a rather radical evolution from this prescription practice to approaches that were thought to be contraindicated at one time, such as beta blocker and vasodilator therapy. Indeed, treatment paradigms today are shifting rapidly toward more complete attenuation of adrenergic processes known to be detrimental in this setting. It is important to review the recent clinical trials that have given us further insight into managing heart failure. Twenty trials published since 1995 have been selected because of the important insight they give us regarding the wide spectrum of therapeutic options available for individuals with heart failure.