Update in the approach to and management of heart failure.

Heart failure (HF) is a prevalent and morbid chronic disease that patients experience in stages. Progression through the stages of HF can be slowed with optimal medical therapy. Although HF remains a clinical diagnosis made at the bedside, measurement of serum brain natriuretic peptide (BNP) can help in the diagnosis when there is uncertainty. The initial workup for patients with newly diagnosed HF is directed at identifying the underlying cause of left ventricular dysfunction. An assessment of hemodynamic status, determined by a careful physical examination, can be used to direct therapy. Angiotensin-converting enzyme inhibitors (ACEIs) and beta blockers remain the two most important therapies for patients with chronic HF. Aldosterone antagonists improve mortality but require close monitoring for severe hyperkalemia. Angiotensin-receptor blockers (ARBs) are excellent alternatives to ACEIs for ACEI-intolerant patients. Digoxin, a second line agent in HF, improves symptoms without mortality benefit. Successful management of HF requires aggressive management of comorbid conditions and careful follow up to slow disease progression, optimize functional status, and improve longevity.