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[Drugs prescribed for chronic heart failure. Current data on their effectiveness]
1Service de Pharmacologie Clinique, Hôpital Sud, Centre Hospitalier Universitaire d'Amiens. Amiens.chupharmacologie@wanadoo.fr
Insights
Certain drugs effectively treat chronic heart failure, reducing mortality and improving life quality. Converting enzyme inhibitors and specific beta-blockers are recommended, while others show variable or unproven benefits for heart failure prognosis.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Chronic heart failure (CHF) presents a poor prognosis, necessitating effective therapeutic interventions.
- Pharmacological treatments aim to reduce mortality and enhance the quality of life for CHF patients.
Purpose of the Study:
- To review the efficacy of various drugs in managing chronic heart failure.
- To categorize medications based on their proven impact on mortality and patient outcomes in CHF.
Main Methods:
- Review of existing clinical data and studies on drug efficacy in heart failure.
- Classification of drugs based on evidence for mortality reduction and functional improvement.
- Analysis of indications and contraindications for commonly used heart failure medications.
Main Results:
- Converting enzyme inhibitors (CEI) and certain beta-blockers (metoprolol, bisoprolol, carvedilol) demonstrate proven efficacy in reducing mortality.
- Carvedilol shows significant mortality reduction and improved function, recommended with CEI and diuretics for symptomatic CHF.
- Diuretics, nitrates, and digitalis improve function but lack conclusive mortality data; aldosterone antagonists show preliminary positive effects.
Conclusions:
- CEI and specific beta-blockers are cornerstone therapies for chronic heart failure.
- Drug selection should be guided by proven efficacy in reducing mortality and improving CHF prognosis.
- Further research is needed for drugs with insufficiently proven efficacy, while some have limited indications for specific patient groups.
Abstract:
VARIABLE EFFICACY: Prognosis in patients with chronic heart failure remains poor. Certain drugs can lower mortality and improve quality of life. DRUGS WITH PROVEN EFFICACY: Converting enzyme inhibitors (CEI) have proven efficacy and should be used in all stages of heart failure outside contraindications. High-dose regimens are recommended when tolerated. Certain beta-blockers have also been added to the list of effective drugs for heart failure. Positive data have been reported for metroprolol, bisoprolol and carvedilol. Improved function has been demonstrated only with carvedilol allowing a clear reduction in mortality; it is currently indicated in combination with CEI and diuretics for patients with symptomatic heart failure. DRUGS WITH INSUFFICIENTLY PROVEN EFFICACY: Certain drugs which have been used for many years can improve heart function but data clearly proving lower mortality are lacking. These include diuretics and nitrate derivatives for symptomatic patients and digitalics which are useful not only for patients with complete arrhythmia due to atrial fibrillation but also for symptomatic patients with sinus rhythm. According to preliminary studies, aldosterone antagonists appear to have a positive effect on mortality due to heart failure. DRUGS WITH LIMITED INDICATIONS: Other drugs have been found to have no effect on mortality. Amiodarone, amlodipine and felodipine can thus be used for patients with associated diseases. Finally anticoagulant therapy should be reserved for patients with atrial fibrillation or a history of thromboembolism.