Are symptoms the most important target for therapy in chronic heart failure?

Symptoms combined with a loss of quality of life can be considered part of the morbidity of heart failure. Patients with chronic heart failure (CHF) have a poorer quality of life than do those with other chronic conditions including arthritis and lung disease. Although there is no evidence to show a mortality benefit, diuretics are frequently used for symptomatic relief in CHF patients. Angiotensin converting enzyme (ACE) inhibitors have been shown both to improve symptoms and to reduce mortality; however, ACE inhibitors have yet to show any conclusive benefit in improving quality of life. Digoxin is widely used and offers symptomatic relief, but it has been shown to have no overall effect on mortality. More recently, certain beta-blockers have been shown to impact both morbidity and mortality in patients already receiving standard therapy including an ACE inhibitor and diuretics. This article reviews these and additional therapies currently used in the management of CHF in the context of their impact on the joint goals of reducing both morbidity and mortality.