Neurohormonal factors in heart failure.

Currently there are 4 to 5 million people with congestive heart failure in the United States. They consume greater than 7% of the total health care dollar of which a significant portion is directly related to hospitalization expenses alone. Most patients with chronic congestive heart failure can be managed efficiently outside the hospital setting by the proper use of nonpharmacologic therapies. Neurohormonal pathways have a significant impact on the progression of congestive heart failure. Medications, which include alpha-blockers, beta-blockers, digoxin, spironolactone, and diuretics, now can block, modify, or manage most of these neurohormonal effects, and therefore, have a stabilizing effect on the patient with congestive heart failure. Understanding the physiology and medications involved for optimal treatment of congestive heart failure is a must to ensure the quality of life that these patients deserve.