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Pharmacologic therapy for patients with chronic heart failure and reduced systolic function: review of trials and practical considerations.

Publication ,  Journal Article
Klein, L; O'Connor, CM; Gattis, WA; Zampino, M; de Luca, L; Vitarelli, A; Fedele, F; Gheorghiade, M
Published in: Am J Cardiol
May 8, 2003

Heart failure (HF) is a complex clinical syndrome resulting from any structural or functional cardiac disorder impairing the ability of the ventricles to fill with or eject blood. The approach to pharmacologic treatment has become a combined preventive and symptomatic management strategy. Ideally, treatment should be initiated in patients at risk, preventing disease progression. In patients who have progressed to symptomatic left ventricular dysfunction, certain therapies have been demonstrated to improve survival, decrease hospitalizations, and reduce symptoms. The mainstay therapies are angiotensin-converting enzyme (ACE) inhibitors and beta-blockers (bisoprolol, carvedilol, and metoprolol XL/CR), with diuretics to control fluid balance. In patients who cannot tolerate ACE inhibitors because of angioedema or severe cough, valsartan can be substituted. Valsartan should not be added in patients already taking an ACE inhibitor and a beta-blocker. Spironolactone is recommended in patients who have New York Heart Association (NYHA) class III to IV symptoms despite maximal therapies with ACE inhibitors, beta-blockers, diuretics, and digoxin. Low-dose digoxin, yielding a serum concentration <1 ng/mL can be added to improve symptoms and, possibly, mortality. The combination of hydralazine and isosorbide dinitrate might be useful in patients (especially in African Americans) who cannot tolerate ACE inhibitors or valsartan because of hypotension or renal dysfunction. Calcium antagonists, with the exception of amlodipine, oral or intravenous inotropes, and vasodilators, should be avoided in HF with reduced systolic function. Amiodarone should be used only if patients have a history of sudden death, or a history of ventricular fibrillation or sustained ventricular tachycardia, and should be used in conjunction with an implantable defibrillator [corrected]. Finally, anticoagulation is recommended only in patients who have concomitant atrial fibrillation or a previous history of cerebral or systemic emboli.

Duke Scholars

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

May 8, 2003

Volume

91

Issue

9A

Start / End Page

18F / 40F

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Systole
  • Isosorbide Dinitrate
  • Hydralazine
  • Humans
  • Heart Failure
  • Diuretics
  • Clinical Trials as Topic
  • Cardiovascular System & Hematology
  • Cardiotonic Agents
 

Citation

APA
Chicago
ICMJE
MLA
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Klein, L., O’Connor, C. M., Gattis, W. A., Zampino, M., de Luca, L., Vitarelli, A., … Gheorghiade, M. (2003). Pharmacologic therapy for patients with chronic heart failure and reduced systolic function: review of trials and practical considerations. Am J Cardiol, 91(9A), 18F-40F. https://doi.org/10.1016/s0002-9149(02)03336-2
Klein, Liviu, Christopher M. O’Connor, Wendy A. Gattis, Manuela Zampino, Leonardo de Luca, Antonio Vitarelli, Francesco Fedele, and Mihai Gheorghiade. “Pharmacologic therapy for patients with chronic heart failure and reduced systolic function: review of trials and practical considerations.Am J Cardiol 91, no. 9A (May 8, 2003): 18F-40F. https://doi.org/10.1016/s0002-9149(02)03336-2.
Klein L, O’Connor CM, Gattis WA, Zampino M, de Luca L, Vitarelli A, et al. Pharmacologic therapy for patients with chronic heart failure and reduced systolic function: review of trials and practical considerations. Am J Cardiol. 2003 May 8;91(9A):18F-40F.
Klein, Liviu, et al. “Pharmacologic therapy for patients with chronic heart failure and reduced systolic function: review of trials and practical considerations.Am J Cardiol, vol. 91, no. 9A, May 2003, pp. 18F-40F. Pubmed, doi:10.1016/s0002-9149(02)03336-2.
Klein L, O’Connor CM, Gattis WA, Zampino M, de Luca L, Vitarelli A, Fedele F, Gheorghiade M. Pharmacologic therapy for patients with chronic heart failure and reduced systolic function: review of trials and practical considerations. Am J Cardiol. 2003 May 8;91(9A):18F-40F.
Journal cover image

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

May 8, 2003

Volume

91

Issue

9A

Start / End Page

18F / 40F

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Systole
  • Isosorbide Dinitrate
  • Hydralazine
  • Humans
  • Heart Failure
  • Diuretics
  • Clinical Trials as Topic
  • Cardiovascular System & Hematology
  • Cardiotonic Agents