Nov 26, 2008

Treatment of patients with heart failure and preserved ejection fraction

Current Treatment Options in Cardiovascular Medicine
Anita Deswal, Biykem Bozkurt

Abstract

Of the more than 5 million Americans who have heart failure (HF), 30% to 50% have HF with preserved ejection fraction (HF-PEF). HF-PEF commonly occurs in elderly patients, especially women, with comorbidities of hypertension, left ventricular hypertrophy, diabetes, myocardial ischemia, and obesity. HF-PEF is associated with high morbidity and mortality. Although two large multicenter randomized, placebo-controlled trials evaluating an angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin receptor blocker (ARB) in patients with HF-PEF did not demonstrate any statistically significant benefit in their primary end points, they did suggest that these agents may have a modest role in reducing HF hospitalizations. Although calcium channel blockers and beta-blockers may be of benefit in patients with HF-PEF, large clinical trial data are not available to support their routine use in all patients with HF-PEF. Subgroup analysis does not support the use of digoxin in patients with HF-PEF in sinus rhythm. Current therapeutic recommendations for HF-PEF are aimed at 1) management of HF symptoms with sodium and fluid restriction along with diuretics for volume overload and 2) treatment of concomitant comorbidities, especially hyp...Continue Reading

  • References49
  • Citations3

Citations

Mentioned in this Paper

Morbidity Aspects
Aldosterone Measurement
Fluid Overload
Spironolactone
Digoxin
ACE2
Sinus - General Anatomical Term
Myocardial Ischemia
Coronary Arteriosclerosis
Atrial Fibrillation

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