Chronic congestive heart failure. Where have we been? Where are we heading?

Chronic congestive heart failure is a frequently occurring disease associated with an impaired quality of life and significant mortality rate. Progress has been made in dissecting the pathophysiologic changes of congestive failure and in using vasodilators, newer positive inotropic agents, and other treatment modalities. Despite these advances, the overall mortality rate from congestive heart failure has not decreased. Further, many unanswered questions remain: How and why does a myocardial cell die? How should quality of life be measured? When should vasodilators and positive inotropic agents be given? What role do receptors play in pathogenesis and therapy? Can sudden death in heart failure be prevented? These and other questions will provide the stimulus for further studies in congestive heart failure.