The Journal of the American Board of Family Practice, Vol 15, Issue 1 39-49, Copyright © 2002 by American Board of Family Practice

ARTICLES

Higher expectations for management of heart failure: current recommendations

W. T. Abraham and L. Scarpinato
Division of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington, USA.

BACKGROUND: Some 4.6 million Americans are estimated to suffer from heart failure, and approximately 400,000 new cases are diagnosed each year. Each year 260,000 patients die as a direct or indirect result of the disorder, with annual costs estimated between $21 billion to $40 billion. METHODS: The medical literature was searched using the key words "heart failure," "beta-adrenergic blockade," "angiotensin-converting enzyme inhibition," and "carvedilol." A case study illustrates the value of an emerging pharmacologic approach for some heart failure patients and places it in clinical perspective. RESULTS: During the past decade, placebo-controlled clinical trials have shown decreased morbidity and mortality resulting from timely intervention using a targeted multidrug approach: first, diuresis; then angiotensin-converting enzyme inhibition and beta-adrenergic-receptor blockade, possibly with digoxin for symptomatic relief. CONCLUSIONS: An emerging approach to therapy aims to reverse the course of left ventricular dysfunction and arrest the underlying disease process, as well as improve hemodynamic function. Management of heart failure has thus entered a new era of more effective pharmacotherapy, often delivered within the primary care setting.