Current medical therapy for advanced heart failure

Abstract

S ignificant progress in the management of cardiovascular disorders has been made in the United States in the past 2 decades, as reflected by a 50% reduction in the age-specific coronary artery disease mortality rate . 1,2 Despite such advances, the prevalence of chronic heart failure has been increasing, 3-7 most likely because of the aging of the U .S. population . 8 In the Framingham study, for example, the prevalence of chronic heart failure was 1% in persons between the ages of 50 and 59 years and increased progressively with age, reaching 10% in persons older than 80 years . 8 Heart failure afflicts an estimated 4 to 5 million individuals in the United States at a cost in excess of $12 billion annually, excluding costs related to lost wages and productivity. 9 10 The cost of hospitalization alone exceeds $7 billion . 10,11 Only a relatively small fraction of this expenditure is attributable to drug management and physician visits . 9,12 Although approximately 4 to 5 million patients have chronic heart failure in the United States, only a few hundred thousand are estimated to have advanced heart failure . This group of patients with advanced heart failure is likely to consume most of our resources . This review will examine current medical therapy for the management of advanced heart failure including digoxin, diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, hydralazine and nitrates combination, Padrenergic blocking agents, calcium-channel blockers, oral and intravenous inodilators, antiarrhythmic agents, anticoagulants, and antiplatelet agents . Unfortunately, limited data are available in patients