Guideline for the management of heart failure caused by systolic dysfunction: part II. Treatment

• Published in: American family physician Vol. 64; no. 6; pp. 1045 - 1054
• Main Authors: Chavey, 2nd, W E, Blaum, C S, Bleske, B E, Harrison, R V, Kesterson, S, Nicklas, J M
• Format: Journal Article
• Language: English
• Published: United States American Academy of Family Physicians 15-09-2001
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Blood Pressure - drug effects; Cardiotonic Agents - therapeutic use; Cardiovascular disease; Diet; Digoxin - therapeutic use; Diuretics - therapeutic use; Drug therapy; Exercise; Health care; Heart Failure - drug therapy; Heart Failure - etiology; Humans; Patient Education as Topic; Referral and Consultation; Systole; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - drug therapy
• ISSN: 0002-838X

Several large clinical trials conducted over the past decade have shown that pharmacologic interventions can dramatically reduce the morbidity and mortality associated with heart failure. These trials have modified and enhanced the therapeutic paradigm for heart failure and extended treatment goals beyond limiting congestive symptoms of volume overload. Part II of this two-part article presents treatment recommendations for patients with left ventricular systolic dysfunction. The authors recommend that, if tolerated and not contraindicated, the following agents be used in patients with left ventricular systolic dysfunction: an angiotensin-converting enzyme inhibitor in all patients; a beta blocker in all patients except those who have symptoms at rest; and spironolactone in patients who have symptoms at rest or who have had such symptoms within the past six months. Diuretics and digoxin should be reserved, as needed, for symptomatic management of heart failure. Other treatments or treatment programs may be necessary in individual patients.