Symptomatic heart failure (HF), generally defined as New York Heart Association (NYHA) class II to IV, is associated with increased mortality that is due primarily to progression of the myocardial dysfunction (table 1). (See "Prognosis of heart failure".)
Treatment of HF is aimed at three goals: improvement in symptoms, slowing of disease progression, and prolongation of survival :
- Improvement in symptoms can be achieved in appropriately selected patients with systolic heart failure by a variety of drugs, including digitalis, diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, and aldosterone antagonists, as well as by cardiac resynchronization therapy.
- Prolongation of patient survival in appropriately selected patients with systolic heart failure has been documented with angiotensin converting enzyme (ACE) inhibitors, beta blockers, aldosterone antagonists, cardiac resynchronization, and implantable cardioverter-defibrillator therapy.
In addition to medical therapy, consideration should be given to possible reversible causes of myocardial dysfunction (eg, coronary revascularization and cessation of alcohol intake).
Possibly effective emerging therapies for heart failure due to systolic dysfunction will be reviewed here. These interventions have been shown to have promise in small studies, as described below, but the risk/benefit ratio and true efficacy remain to be proven. Standard therapy for systolic HF, the management of diastolic HF, and unproven therapies for HF are discussed elsewhere. (See "Overview of the therapy of heart failure due to systolic dysfunction" and "Treatment and prognosis of diastolic heart failure" and "Unproven therapies for chronic systolic heart failure".)