Higher expectations for management of heart failure: current recommendations.

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.