Heart failure secondary to left ventricular systolic dysfunction. Therapeutic advances and treatment recommendations.

Although heart failure secondary to left ventricular systolic dysfunction remains a serious disease with high morbidity and mortality, pharmacologic intervention has been shown to be associated with improved survival and a decreased number of hospitalizations. Primary-care providers must be aware of the potential benefits of recent therapeutic advances and current treatment recommendations for patients with heart failure to receive optimal care. Important aspects of nonpharmacologic care are dietary restrictions, exercise training, and through patient education and counseling. Pharmacologic therapy includes diuretics, angiotensin-converting enzyme inhibitors (ACE) and other vasodilating agents, and digoxin. ACE inhibitors are currently recommended for all patients with left ventricular dysfunction in whom use of these agents is not contraindicated. The mortality and morbidity from heart failure even with ACE inhibitors remain high, however. Promising clinical findings with such investigational agents as vesnarinone and pimobendan and the new-generation beta-blocker carvedilol suggest future new treatments to further improve the prognosis of these patients.