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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2004 December;163(6):209-25

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: Italian

The clinical trials for the treatment of chronic heart failure

Perna P. ¹, Perillo G. ²

¹ A.O. Salerno San Giovanni di Dio e Ruggi d’Aragona, Struttura Complessa di Medicina Interna, Salerno; ² A.O. Salerno San Giovanni di Dio, Dipartimento di Medicina Interna e delle Specialità Mediche, Struttura Complessa di Malattie dell’Apparato Respiratorio, Salerno

Chronic heart failure (CHF) is the fastest-growing cardiovascular disease, and a serious problem for public health systems due to its prevalence and incidence in the general population of industrialized countries. The principal objective of CHF management is to decrease CHF mortality and morbidity, but also to improve the quality of the patients’ life, and to reduce frequent hospitalizations which represent the major burden to health-care system. Interna-tional CHF guidelines underlie the importance of this kind of integrated management of CHF patients. The therapeutic approach in chronic heart failure due to systolic cardiac dysfunction consists of general advice and other non-pharmacological measures, pharmacological therapy, mechanical devices and surgery. Ace-inhibitor agents are recommended as first-line therapy in patients with a reduced left ventricular systolic function expressed as a subnormal ejection fraction. Ace-inhibition significantly improves survival and symptoms, and reduces hospitalisation of patients with moderate and severe heart failure and left ventricular systolic dysfunction. Beta-blocker agents reduce the risk of disease progression in patients with chronic heart failure, but their use is underestimated in clinical practice despite their proven benefits. The central role played by aldosterone receptor antagonists and angiotensin II receptor antagonist agents is an important goal in the treatment of patients with heart failure and left ventricular dysfunction. Revascularization procedures, mitral valve surgery, cardiomyoplasty and partial left ventriculotomy, resynchronization therapy using bi-ventricular pacing represent significant pathways in the therapy of patients with heart failure of ischaemic origin which restore chronically hypoperfused or repetitively stunned mjocytes but which remain viable even though hypo-or akinetic. The aim of this paper is to provide pratical guidelines for the assessment and treatment of heart failure for use in clinical practiceas well as for epidemiological surveys and clinical trials.