Chronic Heart Failure Guidelines

Chronic heart failure (CHF) is common, deadly, disabling, costly but fortunately – treatable. During the last ten to 15 years, treatment of CHF has been dramatically improved by pharmacological therapy and devices. Treatment also has become more complicated. The Guidelines are intended as a support for practising physicians and other health care professionals as most patients with CHF are treated by non-cardiologists. Heart failure clinics are common in Scandinavia with specialized nurses managing patients.

Diagnosis

Symptoms and signs are essential for the diagnosis as they alert the observer to the possibility that heart failure exists. The clinical suspicion of heart failure must be confirmed by more objective tests particularly aimed at assessing cardiac function.

Treatment

Treatment of CHF is aimed at prolonging life and reducing morbidity and symptoms. Quality of life in patients with CHF is reduced as exemplified by frequent hospitalisations when symptoms increase. Hospitalisations for heart failure are costly and reductions are important.

Therapy should include a combination of agents counteracting the adrenergic and renin-angiotensin systems. New neurohormonal antagonists, ACE-inhibitors and beta-blockers together with diuretics make the platform for therapy.

The most recent pharmacologic experience demonstrates the value of ARBs not only as an alternative to ACE-inhibitors but also in addition to these important agents both in CHF as well as in heart failure after MI. The role of aldosterone antagonists has expanded to left ventricular dysfunction after a myocardial infarction.

The role of device therapy (biventricular pacing and ICDs) on top of optimal pharmacological therapy has been markedly expanded during the last year with new trials clarifying the possibilities with these products.

Conclusion

Treatment of CHF has advanced further with more options providing additional life-saving therapies beyond and above ACE-inhibitors and beta-blockers.