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A Journal on Heart and Vascular Diseases


Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2005 August;53(4):233-40

language: English

Pharmacological treatment of chronic heart failure according to the 2005 guidelines of the European Society of Cardiology

Voors A. A., van Veldhuisen D. J.


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Recently, the updated guidelines for the diagnosis and treatment of chronic heart failure were published. This review focuses on the pharmacological treatment. Basically, all patients with chronic heart failure and left ventricular systolic dysfunction should be treated with diuretics, ACE-inhibitors and beta-blockers, unless contra-indicated or not tolerated. It is important to uptitrate ACE-inhibitors and beta-blockers to the high recommended doses that were used in the randomised clinical trials. If an ACE-inhibitor is not tolerated or contra-indicated, it is recommended to start an angiotensin receptor blocker (ARB). Dose and choice of diuretics (loop acting or thiazides or combination) depends on volume status, renal function, and severity of heart failure. If patients remain symptomatic (NYHA class II), an ARB can be added, mainly to reduce worsening of heart failure and related hospitalisation. If patients remain severely symptomatic (NYHA class III), it is recommended to either add an aldosterone blocker, an ARB or both. The choice between an aldosterone blocker and an ARB depends on volume status, other specific patient characteristics, side effects, and personal preference. If all other therapies fail, one might consider nitrates, hydralazine and/or digoxin, while digoxin is always recommended in chronic heart failure patients with atrial fibrillation. Therefore, treatment of chronic heart failure is relatively simple. Although individual patient characteristics should always be taken into account, the current recommendations apply to all patients with chronic heart failure, irrespective its underlying cause.

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