Aug 27 2005
By
DrRich
Two major professional societies, the American Heart Association and the American College of Cardiology, recently published updated guidelines for managing heart failure. ( Read a quick and easy review of heart failure here.) These new guidelines take into account a host of randomized clinical trials that have been reported since 2001, the last time guidelines for heart failure were released.
Major changes since 2001 include:
- The use of beta blockers is now emphasized. Doctors should use beta blockers in all stable patients with heart failure and a reduced left ventricular ejection fraction, unless there is a firm medical reason not to. While many beta blockers are available, doctors should use one of the three beta blockers that have been shown in clinical trials to reduce the risk of death: bisoprolol, carvedilol, or sustained release metoprolol.
- Implantable defibrillators should be recommended for heart failure patients with left ventricular ejection fractions less than 31% (unless the patient is considered nearly end-stage,) and ought to be considered for those with ejection fractions between 31 - 35%.
- Heart failure patients with ejection fractions 35% or less who also have wide QRS complexes on their ECG should be considered for cardiac resynchronization therapy (CRT). ( Read about CRT here.)
- Use of aldosterone antagonists (such as spironolactone) is reasonable in patients with heart failure, as long as kidney function is reasonably normal and potassium balance is not a problem. (Early enthusiasm with spironolactone has been blunted by newer studies showing a worse outcome in patients with kidney disease.)
- The combination of isosorbide dinitrate and hydralazine should be considered in black patients with heart failure, and in anybody else who does not tolerate ACE inhibitors.
