New studies influencing treatment of heart failure: 2006 update.

The number of hospitalizations for heart failure has continued to increase despite rapid and significant advances in cardiovascular care. The mortality rate is lower, but morbidity remains significant. In 2004, over 1 million people were hospitalized for heart failure. Conservative estimates indicate that the United States spends more than $33 billion annually, with hospital and nursing home costs consuming 75% of the total, home health care 10%, care providers 8%, and drugs and medical durables 8%. Angiotensin-converting enzyme inhibitor use confers a 16-20% reduction in mortality. beta-Blocker use also confers a significant reduction in mortality, as well as reduces hospitalizations. Angiotensin II receptor blockers also reduce mortality and morbidity. Appropriate use of drugs can reduce other costs associated with heart failure. During the past 20 years, many trials in patients with heart failure have been conducted. Those that have demonstrated reductions in morbidity and mortality were reviewed in order to identify the important implications for sound clinical care of patients with heart failure. Managed care practitioners and pharmacists who take the time to revisit pertinent studies will understand how each incremental knowledge enhancement builds on previous data. They will also know which agents are preferred based on well-conducted clinical trials, as well as the target doses at which these agents should be used.