Peer Reviewed
Feature Article Cardiovascular medicine

Management of chronic heart failure: a pill too far?

Andrew Sindone, Chadi Ayoub
Abstract
Chronic heart failure is an increasingly common condition associated with high mortality, poor quality of life and recurrent hospitalisation. Management involves identification and treatment of reversible causes and the use of nonpharmacological, medical and device therapies.
Key Points
  • Chronic heart failure is a common, costly and debilitating disease, which has a higher mortality than that of most cancers.
  • All patients suspected of having heart failure should be seen at least once by a cardiologist to help guide therapy and investigate for ischaemia, valvular or pericardial disease.
  • Patients with heart failure should undergo echocardiography for diagnosis and to help guide treatment.
  • Measurement of plasma B-type natriuretic peptide levels is often useful in the diagnosis of heart failure and to guide therapy in difficult cases.
  • All patients with heart failure should be treated with ACE inhibitors and beta blockers unless contraindicated.
  • Aldosterone antagonists are useful in patients who are resistant to treatment, whereas digoxin and diuretics are mainly used for symptom control as they do not improve long-term survival.
  • Regular exercise, patient support programs and cardiac devices play an important role in further managing patients with heart failure.
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