Improving patient care: some unresolved issues in heart failure.

Angiotensin-converting enzyme (ACE) inhibitors are considered as the cornerstone of the treatment of congestive heart failure with systolic dysfunction, proving beneficial in all grades of heart failure, from I to IV on the New York Heart Association scale. However, despite these positive results, a brief glance at the published mortality data or an hour spent in any heart failure clinic easily demonstrates that the problems of heart failure are far from being solved. Among the unresolved issues that will be addressed in this brief review are: the high incidence of deaths due to pump failure and sudden death in patients receiving ACE inhibitor therapy; methods of further improving exercise tolerance and quality of life, and, finally, current views regarding prevention of heart failure.