Drug Therapy Recommendations from the 2005 ACC/AHA Guidelines for Treatment of Chronic Heart Failure

• Published in: The Annals of pharmacotherapy Vol. 40; no. 9; pp. 1607 - 1617
• Main Authors: Howard, Patricia A, Cheng, Judy WM, Crouch, Michael A, Colucci, Vincent J, Kalus, James S, Spinler, Sarah A, Munger, Mark
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA Harvey Whitney Books 01-09-2006; SAGE Publications; Whitney
• Subjects: American Heart Association; Biological and medical sciences; Cardiology - standards; Cardiology. Vascular system; Chronic Disease; Health Planning Guidelines; Heart; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Medical sciences; Pharmacology. Drug treatments; Practice Guidelines as Topic - standards; Societies, Medical; United States; United States; practice guidelines; chronic heart failure; Human; Heart failure; Chemotherapy; Chronic; Treatment; Heart disease; Pharmacotherapy; Cardiovascular disease; Recommendation
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.1H059

Objective:
To review and discuss key aspects of the drug therapy recommendations in the American College of Cardiology (ACC)/American Heart Association (AHA) 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure (HF) in the Adult.
Data Sources:
Data were obtained from the ACC/AHA 2005 Guideline Update for Chronic HF. English-language clinical trials, observational studies, and pertinent review articles evaluating the pharmacotherapy of chronic HF were identified, based on MEDLINE searches through January 2006.
Study Selection:
Articles presenting information that impacts the evidence base for recommendations regarding the use of various drug therapies in patients with chronic HF were evaluated.
Data Synthesis:
The ACC/AHA 2005 Guideline Update for HF provides revised, evidence-based recommendations for the treatment of chronic HF. The new guidelines are based on a staging system that recognizes both the development and progression of HF. Recommendations are provided for 2 stages of patients (A and B) who do not yet have clinical HF but are clearly at risk and 2 stages (C and D) that include patients with symptomatic HF. The guidelines continue to emphasize the important role of neurohormonal blockade with angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, β-adrenergic blockers, and aldosterone antagonists. Based on recent trials, updated recommendations address the roles of combination therapy and the selective addition of hydralazine and isosorbide dinitrate. Along with specific drug recommendations, information on the practical use of various drugs is provided. Although the guidelines primarily focus on HF due to systolic dysfunction, general recommendations are also provided for patients with preserved systolic function.
Conclusions:
The ACC/AHA 2005 Guideline Update provides evidence-based recommendations for healthcare professionals involved in the care of adults with chronic HF. Recent clinical trial findings have further clarified the evolving role of neurohormonal-blocking drugs in the prevention and treatment of HF.