Medical therapies for the management of cardiomyopathy and chronic congestive heart failure
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Corresponding author Deborah Meyers, MD, FRACP Department of Cardiology, Division of Internal Medicine, University of Texas Houston, 6431 Fannin Street, Suite MSB 1.246, Houston, TX 77030, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2009, 3:315–322 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2009 by Current Medicine Group LLC
Medical therapy for congestive heart failure has rapidly evolved over the past decade to include a spectrum of therapies that extend well beyond the traditional pharmaceutical-based strategies of the past. These therapies include multidisciplinary care, transplantation, device-based therapies with resynchronization, defibrillator therapy, and an expanding array of circulatory support devices designed for patients with both acute and chronic heart failure. It is critical that clinicians develop an understanding of the illness trajectory associated with heart failure progression in order to choose the most appropriate management strategies for each stage of the disease.
Introduction The boundaries of what has been traditionally thought of as “best-practice” medical care in heart failure (HF) are expanding rapidly. Many evidence-based pharmaceutical treatments have demonstrated enormous benefits in management of HF, but the conventional lines of what is considered “medical therapy” are becoming increasingly blurred. Medications that comprised the traditional tools of the medical specialist are now part of a new era where multidisciplinary care, device therapies, transplantation, and recovery-directed therapies are increasingly important tools for the clinician treating patients with HF. This article reviews some of the established therapies and looks at what is on the horizon.
Epidemiology of Cardiomyopathy and HF HF is a growing problem worldwide. In the United States alone, HF affects more than 5 million individuals and
is associated with substantial morbidity, mortality, and a poor quality of life. As the HF epidemic continues to grow, so does the cost of caring for these patients, which is estimated to exceed $34 billion annually [1]. Hospitalizations required for treatment of exacerbations of HF account for the bulk of this expenditure. HF is a clinical syndrome that occurs when the heart muscle cannot pump adequate amounts of blood to meet the needs of the body. The syndrome consists of a constellation of signs and symptoms that reflect high cardiac fi lling pressures (ie, congestion) and/or hypoperfusion (ie, lack of adequate blood flow to fulfi ll the needs of the body) at rest or on exertion. Cardiomyopathy (CM) refers to any pathology that affects the heart muscle. Patients with CM can be symptomatic with HF or not, although usually symptoms will manifest over time. In most cases, HF and CM are chronic, progressive conditions associated with a poor prognosis [2]. The development of clinical HF is the fi nal common pathway for a variety of conditions that can impair the heart’s ability to function properly. The most common cause of HF in th
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