Michael A Crouch1. 1. Virginia Commonwealth University, Richmond, VA 23298-0533, USA. macrouch@vcu.edu
Abstract
OBJECTIVE: To provide an overview of major drug therapy recommendations within recently revised chronic heart failure (CHF)guidelines. DATA SOURCES: Guideline statements and English-language articles from MEDLINE pertinent to CHF. STUDY SELECTION AND DATA EXTRACTION: Recently published guidelines from the American College of Cardiology (ACC)/American Heart Association (AHA) and the Heart Failure Society of America (HFSA) served as the focus of this review. Prospective comparative trials, review articles, and editorials were also considered. DATA SYNTHESIS: Recommendations within the ACC/AHA and HFSA guidelines continue to provide a systematic, evidence-based approach regarding CHF management. The HFSA guidelines recommend that the severity of clinical disease and functional limitation be characterized using the New York Heart association (NYHA) functional classification system. A key feature of the ACC/AHA guidelines is the use of a staging system that recognizes the development and progression of heart failure. Both guidelines stress the importance of neurohormonal blockade with angiotensin-converting enzyme inhibitors and beta-adrenergic blockers. Moreover, the guidelines expand the role of aldosterone antagonists, angiotensin II receptor blockers, and hydralazine/isosorbide dinitrate, particularly in combination with standard treatments. Diuretics and digoxin remain symptomatic treatments only. CONCLUSIONS: This article summarizes key drug therapy recommendations from the revised ACC/AHA and HFSA guideline statements. Pharmacists caring for CHF patients should be familiar with these recommendations and aid in their implementation.
OBJECTIVE: To provide an overview of major drug therapy recommendations within recently revised chronic heart failure (CHF)guidelines. DATA SOURCES: Guideline statements and English-language articles from MEDLINE pertinent to CHF. STUDY SELECTION AND DATA EXTRACTION: Recently published guidelines from the American College of Cardiology (ACC)/American Heart Association (AHA) and the Heart Failure Society of America (HFSA) served as the focus of this review. Prospective comparative trials, review articles, and editorials were also considered. DATA SYNTHESIS: Recommendations within the ACC/AHA and HFSA guidelines continue to provide a systematic, evidence-based approach regarding CHF management. The HFSA guidelines recommend that the severity of clinical disease and functional limitation be characterized using the New York Heart association (NYHA) functional classification system. A key feature of the ACC/AHA guidelines is the use of a staging system that recognizes the development and progression of heart failure. Both guidelines stress the importance of neurohormonal blockade with angiotensin-converting enzyme inhibitors and beta-adrenergic blockers. Moreover, the guidelines expand the role of aldosterone antagonists, angiotensin II receptor blockers, and hydralazine/isosorbide dinitrate, particularly in combination with standard treatments. Diuretics and digoxin remain symptomatic treatments only. CONCLUSIONS: This article summarizes key drug therapy recommendations from the revised ACC/AHA and HFSA guideline statements. Pharmacists caring for CHFpatients should be familiar with these recommendations and aid in their implementation.