Congestive heart failure treatment of patients with current or prior symptoms of heart failure (Stage C): Difference between revisions

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Revision as of 03:09, 2 November 2011

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Several measures ^[1] have been listed for patients in Stage A or B as previously mentioned and the Class 1 recommendations for those patients are also appropriate for patients with current or previous symptoms of HF. The effectiveness of diuretics and safety of their usage is an important aspect of the treatment that should be closely monitored along daily measurement of weight and moderate sodium restriction. Physical activity is highly recommended, although heavy labor or sports shouldn’t be a part of it, because the reduction of physical activity promotes physical deconditioning, and an increase of weigh which causes more strain on the failing heart.^[2] Patients with chronic conditions such as HF are also recommended to be immunized with influenza and pneumococcal vaccines in order to reduce the risk of respiratory infection.

Drugs that should be avoided or used with caution in patients with HF

Pharmacological therapy should be closely monitored and several classes of drugs should be avoided in case of HF:

Calcium Channel blockers: There is no direct role of these drugs in the management of HF, due to negative and possible deleterious effect in patients with HF due to systolic dysfunction^[3]. Vasoelective Calcium Channel blockers as amlodipine and felodipine have not been linked to adverse effect in HF treatment, but there is no evidence of efficacy for these drugs in the management of HF.^[4] However, amlodipine and felodipine appear to be safe for the treatment of concomitant disease in HF patients, such as angina or hypertension.

Antiarrhythmic agents: Negative inotropic effect exerted by most antiarrhythmic drugs can precipitate HF in patients with reduced LV function. The reduction in LV function can also reduce the elimination of these drugs leading to further drug toxicity. Other antiarrhythmic drugs can induce some proarrhythmic effect, especially class 1 agents and class 3 agents Ibutilide and sotalol;^[5] the same class 3 agents in addition to dofetilide can induce torsades to pointes.

Amiodarone is considered the safest of the antiarrhythmic drugs because of its minimal proarrhythmic effect and is generally the preferred drug for treating arrhythmias in HF patients.

Nonsteroidal anti-inflammatory drugs (NSAID):^[6] The administration of non-selective NSAIDs in HF patients is linked with an increased risk of HF exacerbation, increased renal dysfunction, and abnormal responses to ACEIs and diuretics. COX-2 selective inhibitors have not been fully investigated, but observational studies indicate that they may be linked with an increased rate of HF exacerbation and increased mortality.

Aspirin benefits and risks are not well established in patients with HF and Vascular disease (includingCAD). The potential interaction between ACEIs and beta blockers is of great importance. Although no data has proven that aspirin causes more frequent HF exacerbations and interactions with those drugs, health care providers should be aware of the possibility of such risks, but no recommendation for or against aspirin therapy in patients with heart failure can be made before further data are available.

Oral Hypoglycemic agents:^[7] two oral hypoglycemic agents, metformin and thiazolidinediones are considered to be risky in patients with HF.

Metformin - one of the most common side effects of metformin is lactic acidosis, which can be fatal in patients with HF.

Thiazolidinediones -^[8] the biggest risk of using Thiazolidinediones is fluid retention which may cause severe worsening of patients with HF.

Antidepressants: Depression is a common finding between patients suffering from HF that is usually related to high mortality rate and bad prognosis of those patients.^[9] Limited data are available on the safety and the risks associated with the usage of antidepressants in patients with heart failure. Health care providers should be aware of major cardiovascular events (as HF, MI, Stroke, cardiovascular death ) that is associated with Tricyclic antidepressants (TCAs) and Selective serotonin reuptake inhibitors (SSRIs).

Phosphodiesterase inhibitors PDE – The PDE-3 inhibitors as^[10] Cilostazol and PDE-4 as ^[11] Anagrelide should be avoided in patients with HF, because of an increase risk of high-output heart failure and fluid retention that is associated with those drugs.^[12]

PDE-5 inhibitors such as sildenafil, vardenafil, and tadalafil, are widely used in the management of erectile dysfunction in men. The use of those agents with any form of nitrate therapy is contraindicated because of severe hypotensive effect that can be life threatening.^[13] In a trial where sildenafil and placebo were randomly assigned to 34 HF patients, no significant difference of symptomatic hypotension was observed, but HF patients with borderline low blood pressure and/or low volume status are in risk of severe hypotension and should avoid any PDE-5 inhibitors use.

Chemotherapy – Cardiotoxic chemotherapeutic agents as Cyclophosphamide, Trastuzumab, Bevacizumab and Anthracyclines, should be avoided in HF patients ^[14]

Tumor Necrosis Factor alpha inhibitors TNF-alpha: New onset or worsening of pre-existing heart failure have been linked to TNF-alpha inhibitors.^[15] Infliximab has been specifically contraindicated in doses over 5mg/kg in patients with heart failure.

Antihistamines:^[16] some second generation antihistamines as terfenadine and astemizole have been reported to cause long QT syndrome and should not be used in HF patients.

Serum potassium should be closely monitored in HF patients, in order of preventing either hypokalemia or hyperkalemia, which could greatly affect cardiac excitability and conduction, leading to sudden cardiac death.^[17] Serum potassium should be maintained between 4.0 to 5.0 mEq per liter range, because low potassium level may affect digitalis and antiarrhythmic drugs treatment, while high potassium level can prevent the use of treatments known to prolong life.^[17]

Supervision of HF patients with close monitoring of treatment and diet is a very important aspect of the follow-up process in those individuals. Body weight and medications should be closely monitored, because any minor change in those parameters can have a significant effect over symptoms and hospitalization of patients with HF.^[18] Patient education is a crucial aspect of the management of HF, patient and family surveillance over any new change of symptoms or body weight is important in allowing early detection of those changes and implementing new treatment strategies to reduce further complications.^[19]

Pharmacological Therapy of HF

Improving symptoms, reducing mortality and slowing or reversing myocardial deterioration are the main goals of pharmacological therapy in HF patients. The therapy should be also directed at preventing arrhythmias, embolic events and other exacerbating factors. Different strategies have been implemented in the treatment of HF, but the ACC/AHA recommendations are based on a combination of 3 types of drugs: a Diuretic, an ACEI or an ARB, and a beta blocker^[20]. A review of data from several trials, provide clear evidence supporting the central role of these drugs in HF patient Therapy. The Diuretics play an important role in controlling fluid retention and achieving a euvolemic state. On the other hand, ACEI and a beta blocker should be started and maintained in patients who can tolerate them because of their major effect in controlling symptoms and reducing mortality. Digoxin can be added to this regime as a fourth agent to reduce symptoms, reduce recurrent hospitalization, control great and rhythm, and enhance exercise tolerance.

Diuretics

Different classes of diuretics have been implicated in the treatment of CHF. Loop Diuretics such as furosemide, bumetanide and torsemide, act on the inhibition of sodium and chloride reabsorption in the loop of Henle, whereas thiazide diuretics, metolazone, and potassium sparing diuretics as spironolactone act on the distal portion of the renal tubule. ^[21]Loop diuretics increase sodium secretion up to 25 % of the filtered load of sodium, enhance free water clearance and maintain their efficacy unless severe renal impairment is present.^[22]Thiazide diuretics in contrast, increase the fractional excretion of sodium to a maximum of 10% of the filtered load, decrease free water clearance and lose their efficacy in patients with impaired renal function. For such reasons, loop diuretics are much preferred, unless hypertension with mild fluid retention is present in HF patients, where thiazide diuretics may have a better antihypertensive effect in this case.

Different short-studies demonstrated the efficacy of diuretics in improving various symptoms of HF, reducing jugular venous pressure, pulmonary congestion, peripheral edema and body weight, all within days of initiation of therapy.^[23] No long term studies have been conducted so far to reveal the effects of diuretic therapy on morbidity and mortality, but an improvement in cardiac function and exercise tolerance in patients with HF have been demonstrated in intermediate-term trials.^[24]

Diuretics produce great symptomatic benefits,^[25] much more rapidly than any other drugs for HF, they can adequately control the fluid retention of HF, relieving pulmonary edema and peripheral edema within hours or days. However, Diuretics should not be used alone in controlling Stage C HF. They should be combined with an ACEI and a beta blocker to avoid further clinical deterioration and maintain the HF symptoms under control.^[24]

Appropriate dose of diuretics should used in treatment of HF,^[26] because low doses will cause fluid retention, which can lead to a reduced response to ACEIs and ARBs and an increase risk of decompensation with the use of beta blockers, while excessive diuretics will lead to volume contraction which can increase the risk of hypotension and renal insufficiency with ACEIs, ARBs and beta blockers.^[27]

Loop diuretics are usually the first diuretics to be used to control pulmonary and/or peripheral edema. Furosemide is the most commonly used, but some patients may respond favorably to other agents in this category (as torsemide and Bumetanide) because of superior absorption and longer time of action.^[28]

The starting dosage is usually 20 to 40 mg of furosemide or its equivalent, but the exact dosing should always be monitored according to diuresis and other clinical symptoms, since the ultimate goal is to eliminate the evidence of fluid retention such as jugular venous pressure elevation and peripheral edema. Outpatients with HF are usually started with low dose until urine increases and weigh decreases by 0.5 to 1.0 kg daily. Diuretic therapy should be also combined with moderate dietary sodium restriction. Unstable or severe disease, should be controlled with intravenous diuretics( bolus or continuous infusion) and thiazide diuretics can be added for a synergistic effect.^[29]

Reducing overall volume may decrease intracardiac filling pressure resulting in a lower cardiac output via the Frank-Starling relationship. This effect is usually a minor effect and does not alter the course of the therapy. On the other hand, an unexplained increase in BUN and creatinine should be closely monitored and suspected as a sign of abnormal tissue perfusion. In this case renal function and other end organ perfusion should be assessed to avoid any concomitant complications.

Angiotensin Converting Enzyme Inhibitors

Patients with moderate to severe HF or asymptomatic left ventricular dysfunction show a great improvement in survival rate with the usage of ACE inhibitors.^[30] ACE inhibitors enhance the action of kinins and augment kinin-mediated prostaglandin production, so the effect of ACEIs cannot be solely explained by the suppression of Angiotensin II production. Furthermore, it has been proven that ACEIs modify cardiac remodeling more favorably than ARBs in experimental models of HF.^[31] Several studies indicates that ACEIs can alleviate symptoms,^[32] improve clinical status and sense of well being in patients with HF.

Another important aspect of ACEIs therapy is the reduction of mortality and hospitalization in such patients.^[33] These benefits were noticed in patients with mild, moderate or even severe symptoms of HF, with or without CAD. In general ACEIs should be used together with a beta blocker and should not be used without diuretics in patients with a current or recent history of fluid retention, because of the important role of diuretics in maintaining sodium balance and preventing the development of peripheral and pulmonary edema.^[24]

For the reasons mentioned above, ACEI therapy should be started in asymptomatic or symptomatic patients with HF. The beginning therapy should be a low dose ( eg, 2.5 mg of enalapril twice a day, 6.25 mg of captopril three time a day or 5 mg of lisinopril once a day). The dose should be gradually increased in one to two week if the initial therapy is tolerated and try to target a dose of 20 mg of enalapril twice a day, or 50 mg of captopril three times a day or up to 40 mg of lisinopril a day.^[34] Plasma potassium and renal function should be assessed one to two weeks after starting or changing a dose and periodically thereafter. Physicians should attempt to target certain doses which have been proved to reduce the risk of cardiovascular events. If these target doses of ACEIs cannot be used or poorly tolerated than intermediate doses should be implemented. ^[35]

NSAIDs should be avoided since they may cause an increase in adverse effects of ACEIs in patients with HF and a decrease in the favorable effect of ACEIs therapy.^[24] Some evidence suggests that aspirin may inhibit the acute hemodynamic benefits of ACEIs.^[36] If the patient has a know history of coronary artery disease(CAD) then use of ASA along with ACEIs is recommended. However, but in patients with no history of CAD, there is no evidence to support the use of aspirin. There may be an important interaction between aspirin and ACEIs but there is a lot of controversy regarding this point and it needs further study.

Overview of Treatment of Patients With Current or Prior Symptoms of Heart Failure (Stage C)

ACC / AHA Guidelines- Patients with Reduced LVEF (DO NOT EDIT) ^[37]

“

Class I

1. Measures listed as Class I recommendations for patients in stages A and B are also appropriate for patients in Stage C. (Levels of Evidence: A, B, and C as appropriate)

2. Diuretics and salt restriction are indicated in patients with current or prior symptoms of HF and reduced LVEF who have evidence of fluid retention. (Level of Evidence: C)

3. Angiotensin converting enzyme inhibitors are recommended for all patients with current or prior symptoms of HF and reduced LVEF, unless contraindicated. (Level of Evidence: A)

4. Beta-blockers (using 1 of the 3 proven to reduce mortality, i.e., bisoprolol, carvedilol, and sustained release metoprolol succinate) are recommended for all stable patients with current or prior symptoms of HF and reduced LVEF, unless contraindicated. (Level of Evidence: A)

5. Angiotensin II receptor blockers approved for the treatment of HF are recommended in patients with current or prior symptoms of HF and reduced LVEF who are ACEI-intolerant (as in patients with angioedema). (Level of Evidence: A)

6. Drugs known to adversely affect the clinical status of patients with current or prior symptoms of HF and reduced LVEF should be avoided or withdrawn whenever possible (e.g., non steroidal anti-inflammatory drugs, most antiarrhythmic drugs, and most calcium channel blocking drugs; see text). (Level of Evidence: B)

7. Exercise training is beneficial as an adjunctive approach to improve clinical status in ambulatory patients with current or prior symptoms of HF and reduced LVEF. (Level of Evidence: B)

8. An implantable cardioverter-defibrillator is recommended as secondary prevention to prolong survival in patients with current or prior symptoms of HF and reduced LVEF who have a history of cardiac arrest, ventricular fibrillation, or hemodynamically destabilizing ventricular tachycardia. (Level of Evidence: A)

9. Implantable cardioverter-defibrillator therapy is recommended for primary prevention to reduce total mortality by a reduction in sudden cardiac death in patients with ischemic heart disease who are at least 40 days post-MI, have an LVEF less than or equal to 30%, with NYHA functional class II or III symptoms while undergoing chronic optimal medical therapy, and have reasonable expectation of survival with a good functional status for more than 1 year. (Level of Evidence: A)

10. Implantable cardioverter-defibrillator therapy is recommended for primary prevention to reduce total mortality by a reduction in sudden cardiac death in patients with non ischemic cardiomyopathy who have an LVEF less than or equal to 30%, with NYHA functional class II or III symptoms while undergoing chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 year. (Level of Evidence: B)

11. Patients with LVEF less than or equal to 35%, sinus rhythm, and NYHA functional class III or ambulatory class IV symptoms despite recommended, optimal medical therapy and who have cardiac dyssynchrony, which is currently defined as a QRS duration greater than 0.12 ms, should receive cardiac resynchronization therapy unless contraindicated. (Level of Evidence: A)

12. Addition of an aldosterone antagonist is reasonable in selected patients with moderately severe to severe symptoms of HF and reduced LVEF who can be carefully monitored for preserved renal function and normal potassium concentration. Creatinine should be less than or equal to 2.5 mg/dL in men or less than or equal to 2.0 mg/dL in women and potassium should be less than 5.0 mEq/L. Under circumstances where monitoring for hyperkalemia or renal dysfunction is not anticipated to be feasible, the risks may outweigh the benefits of aldosterone antagonists. (Level of Evidence: B)

Class IIa

1. Angiotensin II receptor blockers are reasonable to use as alternatives to ACEIs as first-line therapy for patients with mild to moderate HF and reduced LVEF, especially for patients already taking ARBs for other indications. (Level of Evidence: A)

2. Digitalis can be beneficial in patients with current or prior symptoms of HF and reduced LVEF to decrease hospitalizations for HF. (Level of Evidence: B)

3. The addition of a combination of hydralazine and a nitrate is reasonable for patients with reduced LVEF who are already taking an ACEI and beta-blocker for symptomatic HF and who have persistent symptoms. (Level of Evidence: A)

4. Placement of an implantable cardioverter-defibrillator is reasonable in patients with LVEF of 30% to 35% of any origin with NYHA functional class II or III symptoms who are taking chronic optimal medical therapy and who have reasonable expectation of survival with good functional status of more than 1 year. (Level of Evidence: B)

Class IIb

1. A combination of hydralazine and a nitrate might be reasonable in patients with current or prior symptoms of HF and reduced LVEF who cannot be given an ACEI or ARB because of drug intolerance, hypotension, or renal insufficiency. (Level of Evidence: C)

2. The addition of an ARB may be considered in persistently symptomatic patients with reduced LVEF who are already being treated with conventional therapy. (Level of Evidence: B)

Class III

1. Routine combined use of an ACEI, ARB, and aldosterone antagonist is not recommended for patients with current or prior symptoms of HF and reduced LVEF. (Level of Evidence: C)

2. Calcium channel blocking drugs are not indicated as routine treatment for HF in patients with current or prior symptoms of HF and reduced LVEF. (Level of Evidence: A)

3. Long-term use of an infusion of a positive inotropic drug may be harmful and is not recommended for patients with current or prior symptoms of HF and reduced LVEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (Stage D). (Level of Evidence: C)

4. Use of nutritional supplements as treatment for HF is not indicated in patients with current or prior symptoms of HF and reduced LVEF. (Level of Evidence: C)

5. Hormonal therapies other than to replete deficiencies are not recommended and may be harmful to patients with current or prior symptoms of HF and reduced LVEF. (Level of Evidence: C)

”

ACC / AHA Guidelines- Patients with HF and Normal LVEF (DO NOT EDIT) ^[37]

“

Class I

1. Physicians should control systolic and diastolichypertension in patients with HF and normal LVEF, in accordance with published guidelines. (Level of Evidence: A)

2. Physicians should control ventricular rate in patients with HF and normal LVEF and atrial fibrillation. (Level of Evidence: C)

3. Physicians should use diuretics to control pulmonary congestion and peripheral edema in patients with HF and normal LVEF. (Level of Evidence: C)

Class IIa

1. Coronary revascularization is reasonable in patients with HF and normal LVEF and coronary artery disease in whom symptomatic or demonstrable myocardial ischemia is judged to be having an adverse effect on cardiac function. (Level of Evidence: C)

Class IIb

1. Restoration and maintenance of sinus rhythm in patients with atrial fibrillation and HF and normal LVEF might be useful to improve symptoms. (Level of Evidence: C)

2. The use of beta-adrenergic blocking agents, ACEIs, ARBs, or calcium antagonists in patients with HF and normal LVEF and controlled hypertension might be effective to minimize symptoms of HF. (Level of Evidence: C)

3. The usefulness of digitalis to minimize symptoms of HF in patients with HF and normal LVEF is not well established. (Level of Evidence: C)

”

Sources

The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult ^[37]

References

↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW (2009). "2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation". Circulation. 119 (14): e391–479. doi:10.1161/CIRCULATIONAHA.109.192065. PMID 19324966. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)
↑ McKelvie RS, Teo KK, McCartney N, Humen D, Montague T, Yusuf S (1995). "Effects of exercise training in patients with congestive heart failure: a critical review". Journal of the American College of Cardiology. 25 (3): 789–96. doi:10.1016/0735-1097(94)00428-S. PMID 7860930. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)
↑ Packer M, Kessler PD, Lee WH (1987). "Calcium-channel blockade in the management of severe chronic congestive heart failure: a bridge too far". Circulation. 75 (6 Pt 2): V56–64. PMID 3552317. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Reed SD, Friedman JY, Velazquez EJ, Gnanasakthy A, Califf RM, Schulman KA (2004). "Multinational economic evaluation of valsartan in patients with chronic heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT)". American Heart Journal. 148 (1): 122–8. doi:10.1016/j.ahj.2003.12.040. PMID 15215801. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)
↑ Torp-Pedersen C, Møller M, Bloch-Thomsen PE, Køber L, Sandøe E, Egstrup K, Agner E, Carlsen J, Videbaek J, Marchant B, Camm AJ (1999). "Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group". The New England Journal of Medicine. 341 (12): 857–65. doi:10.1056/NEJM199909163411201. PMID 10486417. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)
↑ Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A (1998). "NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics". Archives of Internal Medicine. 158 (10): 1108–12. PMID 9605782. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
↑ Gan SC, Barr J, Arieff AI, Pearl RG (1992). "Biguanide-associated lactic acidosis. Case report and review of the literature". Archives of Internal Medicine. 152 (11): 2333–6. PMID 1444694. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
↑ Masoudi FA, Inzucchi SE, Wang Y, Havranek EP, Foody JM, Krumholz HM (2005). "Thiazolidinediones, metformin, and outcomes in older patients with diabetes and heart failure: an observational study". Circulation. 111 (5): 583–90. doi:10.1161/01.CIR.0000154542.13412.B1. PMID 15699279. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
↑ Swenson JR, Doucette S, Fergusson D (2006). "Adverse cardiovascular events in antidepressant trials involving high-risk patients: a systematic review of randomized trials". Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 51 (14): 923–9. PMID 17249635. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
↑ Storen EC, Tefferi A (2001). "Long-term use of anagrelide in young patients with essential thrombocythemia". Blood. 97 (4): 863–6. PMID 11159509. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
↑ "Anagrelide, a therapy for thrombocythemic states: experience in 577 patients. Anagrelide Study Group". The American Journal of Medicine. 92 (1): 69–76. 1992. PMID 1731512. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Lewis GD, Shah R, Shahzad K, Camuso JM, Pappagianopoulos PP, Hung J, Tawakol A, Gerszten RE, Systrom DM, Bloch KD, Semigran MJ (2007). "Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension". Circulation. 116 (14): 1555–62. doi:10.1161/CIRCULATIONAHA.107.716373. PMID 17785618. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
↑ Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L (2001). "Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2". The New England Journal of Medicine. 344 (11): 783–92. doi:10.1056/NEJM200103153441101. PMID 11248153. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
↑ Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT (2003). "Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial". Circulation. 107 (25): 3133–40. doi:10.1161/01.CIR.0000077913.60364.D2. PMID 12796126. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
↑ Yap YG, Camm AJ (2003). "Drug induced QT prolongation and torsades de pointes". Heart (British Cardiac Society). 89 (11): 1363–72. PMC 1767957. PMID 14594906. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
↑ ^17.0 ^17.1 Packer M, Gottlieb SS, Kessler PD (1986). "Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia". The American Journal of Medicine. 80 (4A): 23–9. PMID 2871753. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM (1995). "A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure". The New England Journal of Medicine. 333 (18): 1190–5. doi:10.1056/NEJM199511023331806. PMID 7565975. Retrieved 2011-04-10. Unknown parameter |month= ignored (help)
↑ Philbin EF (1999). "Comprehensive multidisciplinary programs for the management of patients with congestive heart failure". Journal of General Internal Medicine. 14 (2): 130–5. PMID 10051785. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ "Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure". The American Journal of Cardiology. 83 (2A): 1A–38A. 1999. PMID 10072251. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Brater DC (1998). "Diuretic therapy". The New England Journal of Medicine. 339 (6): 387–95. doi:10.1056/NEJM199808063390607. PMID 9691107. Retrieved 2011-04-12. Unknown parameter |month= ignored (help)
↑ Cody RJ, Kubo SH, Pickworth KK (1994). "Diuretic treatment for the sodium retention of congestive heart failure". Archives of Internal Medicine. 154 (17): 1905–14. PMID 8074594. Retrieved 2011-04-12. Unknown parameter |month= ignored (help)
↑ Patterson JH, Adams KF, Applefeld MM, Corder CN, Masse BR (1994). "Oral torsemide in patients with chronic congestive heart failure: effects on body weight, edema, and electrolyte excretion. Torsemide Investigators Group". Pharmacotherapy. 14 (5): 514–21. PMID 7997385. |access-date= requires |url= (help)
↑ ^24.0 ^24.1 ^24.2 ^24.3 Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC (1987). "Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure". Lancet. 2 (8561): 709–11. PMID 2888942. Retrieved 2011-04-14. Unknown parameter |month= ignored (help)
↑ Packer M, Medina N, Yushak M, Meller J (1983). "Hemodynamic patterns of response during long-term captopril therapy for severe chronic heart failure". Circulation. 68 (4): 803–12. PMID 6352079. Retrieved 2011-04-14. Unknown parameter |month= ignored (help)
↑ Risler T, Schwab A, Kramer B, Braun N, Erley C (1994). "Comparative pharmacokinetics and pharmacodynamics of loop diuretics in renal failure". Cardiology. 84 Suppl 2: 155–61. PMID 7954539. |access-date= requires |url= (help)
↑ Cody RJ, Franklin KW, Laragh JH (1982). "Postural hypotension during tilt with chronic captopril and diuretic therapy of severe congestive heart failure". American Heart Journal. 103 (4 Pt 1): 480–4. PMID 7039281. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Vasko MR, Cartwright DB, Knochel JP, Nixon JV, Brater DC (1985). "Furosemide absorption altered in decompensated congestive heart failure". Annals of Internal Medicine. 102 (3): 314–8. PMID 3970471. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Dormans TP, van Meyel JJ, Gerlag PG, Tan Y, Russel FG, Smits P (1996). "Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion". Journal of the American College of Cardiology. 28 (2): 376–82. doi:10.1016/0735-1097(96)00161-1. PMID 8800113. Retrieved 2011-04-14. Unknown parameter |month= ignored (help)
↑ "Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigattors". The New England Journal of Medicine. 327 (10): 685–91. 1992. doi:10.1056/NEJM199209033271003. PMID 1463530. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)
↑ Exner DV, Dries DL, Domanski MJ, Cohn JN (2001). "Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction". The New England Journal of Medicine. 344 (18): 1351–7. doi:10.1056/NEJM200105033441802. PMID 11333991. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)
↑ Carson P, Ziesche S, Johnson G, Cohn JN (1999). "Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group". Journal of Cardiac Failure. 5 (3): 178–87. PMID 10496190. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)
↑ Garg R, Yusuf S (1995). "Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials". JAMA : the Journal of the American Medical Association. 273 (18): 1450–6. PMID 7654275. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, Rydén L, Thygesen K, Uretsky BF (1999). "Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group". Circulation. 100 (23): 2312–8. PMID 10587334. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)
↑ Delahaye F, de Gevigney G (2000). "Is the optimal dose of angiotensin-converting enzyme inhibitors in patients with congestive heart failure definitely established?". Journal of the American College of Cardiology. 36 (7): 2096–7. PMID 11127446. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)
↑ "Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration". BMJ (Clinical Research Ed.). 308 (6921): 81–106. 1994. PMC 2539220. PMID 8298418. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)
↑ ^37.0 ^37.1 ^37.2 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202

Template:WikiDoc Sources

[pmid19324966-1] Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW (2009). "2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation". Circulation. 119 (14): e391–479. doi:10.1161/CIRCULATIONAHA.109.192065. PMID 19324966. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)

[pmid7860930-2] McKelvie RS, Teo KK, McCartney N, Humen D, Montague T, Yusuf S (1995). "Effects of exercise training in patients with congestive heart failure: a critical review". Journal of the American College of Cardiology. 25 (3): 789–96. doi:10.1016/0735-1097(94)00428-S. PMID 7860930. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)

[pmid3552317-3] Packer M, Kessler PD, Lee WH (1987). "Calcium-channel blockade in the management of severe chronic congestive heart failure: a bridge too far". Circulation. 75 (6 Pt 2): V56–64. PMID 3552317. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid15215801-4] Reed SD, Friedman JY, Velazquez EJ, Gnanasakthy A, Califf RM, Schulman KA (2004). "Multinational economic evaluation of valsartan in patients with chronic heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT)". American Heart Journal. 148 (1): 122–8. doi:10.1016/j.ahj.2003.12.040. PMID 15215801. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)

[pmid10486417-5] Torp-Pedersen C, Møller M, Bloch-Thomsen PE, Køber L, Sandøe E, Egstrup K, Agner E, Carlsen J, Videbaek J, Marchant B, Camm AJ (1999). "Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group". The New England Journal of Medicine. 341 (12): 857–65. doi:10.1056/NEJM199909163411201. PMID 10486417. Retrieved 2011-04-07. Unknown parameter |month= ignored (help)

[pmid9605782-6] Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A (1998). "NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics". Archives of Internal Medicine. 158 (10): 1108–12. PMID 9605782. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)

[pmid1444694-7] Gan SC, Barr J, Arieff AI, Pearl RG (1992). "Biguanide-associated lactic acidosis. Case report and review of the literature". Archives of Internal Medicine. 152 (11): 2333–6. PMID 1444694. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)

[pmid15699279-8] Masoudi FA, Inzucchi SE, Wang Y, Havranek EP, Foody JM, Krumholz HM (2005). "Thiazolidinediones, metformin, and outcomes in older patients with diabetes and heart failure: an observational study". Circulation. 111 (5): 583–90. doi:10.1161/01.CIR.0000154542.13412.B1. PMID 15699279. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)

[pmid17249635-9] Swenson JR, Doucette S, Fergusson D (2006). "Adverse cardiovascular events in antidepressant trials involving high-risk patients: a systematic review of randomized trials". Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 51 (14): 923–9. PMID 17249635. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid16549646-10] Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)

[pmid11159509-11] Storen EC, Tefferi A (2001). "Long-term use of anagrelide in young patients with essential thrombocythemia". Blood. 97 (4): 863–6. PMID 11159509. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)

[pmid1731512-12] "Anagrelide, a therapy for thrombocythemic states: experience in 577 patients. Anagrelide Study Group". The American Journal of Medicine. 92 (1): 69–76. 1992. PMID 1731512. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid17785618-13] Lewis GD, Shah R, Shahzad K, Camuso JM, Pappagianopoulos PP, Hung J, Tawakol A, Gerszten RE, Systrom DM, Bloch KD, Semigran MJ (2007). "Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension". Circulation. 116 (14): 1555–62. doi:10.1161/CIRCULATIONAHA.107.716373. PMID 17785618. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)

[pmid11248153-14] Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L (2001). "Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2". The New England Journal of Medicine. 344 (11): 783–92. doi:10.1056/NEJM200103153441101. PMID 11248153. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)

[pmid12796126-15] Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT (2003). "Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial". Circulation. 107 (25): 3133–40. doi:10.1161/01.CIR.0000077913.60364.D2. PMID 12796126. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)

[pmid14594906-16] Yap YG, Camm AJ (2003). "Drug induced QT prolongation and torsades de pointes". Heart (British Cardiac Society). 89 (11): 1363–72. PMC 1767957. PMID 14594906. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)

[pmid2871753-17] 17.0 ^17.1 Packer M, Gottlieb SS, Kessler PD (1986). "Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia". The American Journal of Medicine. 80 (4A): 23–9. PMID 2871753. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid7565975-18] Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM (1995). "A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure". The New England Journal of Medicine. 333 (18): 1190–5. doi:10.1056/NEJM199511023331806. PMID 7565975. Retrieved 2011-04-10. Unknown parameter |month= ignored (help)

[pmid10051785-19] Philbin EF (1999). "Comprehensive multidisciplinary programs for the management of patients with congestive heart failure". Journal of General Internal Medicine. 14 (2): 130–5. PMID 10051785. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid10072251-20] "Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure". The American Journal of Cardiology. 83 (2A): 1A–38A. 1999. PMID 10072251. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid9691107-21] Brater DC (1998). "Diuretic therapy". The New England Journal of Medicine. 339 (6): 387–95. doi:10.1056/NEJM199808063390607. PMID 9691107. Retrieved 2011-04-12. Unknown parameter |month= ignored (help)

[pmid8074594-22] Cody RJ, Kubo SH, Pickworth KK (1994). "Diuretic treatment for the sodium retention of congestive heart failure". Archives of Internal Medicine. 154 (17): 1905–14. PMID 8074594. Retrieved 2011-04-12. Unknown parameter |month= ignored (help)

[pmid7997385-23] Patterson JH, Adams KF, Applefeld MM, Corder CN, Masse BR (1994). "Oral torsemide in patients with chronic congestive heart failure: effects on body weight, edema, and electrolyte excretion. Torsemide Investigators Group". Pharmacotherapy. 14 (5): 514–21. PMID 7997385. |access-date= requires |url= (help)

[pmid2888942-24] 24.0 ^24.1 ^24.2 ^24.3 Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC (1987). "Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure". Lancet. 2 (8561): 709–11. PMID 2888942. Retrieved 2011-04-14. Unknown parameter |month= ignored (help)

[pmid6352079-25] Packer M, Medina N, Yushak M, Meller J (1983). "Hemodynamic patterns of response during long-term captopril therapy for severe chronic heart failure". Circulation. 68 (4): 803–12. PMID 6352079. Retrieved 2011-04-14. Unknown parameter |month= ignored (help)

[pmid7954539-26] Risler T, Schwab A, Kramer B, Braun N, Erley C (1994). "Comparative pharmacokinetics and pharmacodynamics of loop diuretics in renal failure". Cardiology. 84 Suppl 2: 155–61. PMID 7954539. |access-date= requires |url= (help)

[pmid7039281-27] Cody RJ, Franklin KW, Laragh JH (1982). "Postural hypotension during tilt with chronic captopril and diuretic therapy of severe congestive heart failure". American Heart Journal. 103 (4 Pt 1): 480–4. PMID 7039281. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid3970471-28] Vasko MR, Cartwright DB, Knochel JP, Nixon JV, Brater DC (1985). "Furosemide absorption altered in decompensated congestive heart failure". Annals of Internal Medicine. 102 (3): 314–8. PMID 3970471. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid8800113-29] Dormans TP, van Meyel JJ, Gerlag PG, Tan Y, Russel FG, Smits P (1996). "Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion". Journal of the American College of Cardiology. 28 (2): 376–82. doi:10.1016/0735-1097(96)00161-1. PMID 8800113. Retrieved 2011-04-14. Unknown parameter |month= ignored (help)

[pmid1463530-30] "Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigattors". The New England Journal of Medicine. 327 (10): 685–91. 1992. doi:10.1056/NEJM199209033271003. PMID 1463530. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)

[pmid11333991-31] Exner DV, Dries DL, Domanski MJ, Cohn JN (2001). "Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction". The New England Journal of Medicine. 344 (18): 1351–7. doi:10.1056/NEJM200105033441802. PMID 11333991. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)

[pmid10496190-32] Carson P, Ziesche S, Johnson G, Cohn JN (1999). "Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group". Journal of Cardiac Failure. 5 (3): 178–87. PMID 10496190. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)

[pmid7654275-33] Garg R, Yusuf S (1995). "Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials". JAMA : the Journal of the American Medical Association. 273 (18): 1450–6. PMID 7654275. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid10587334-34] Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, Rydén L, Thygesen K, Uretsky BF (1999). "Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group". Circulation. 100 (23): 2312–8. PMID 10587334. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)

[pmid11127446-35] Delahaye F, de Gevigney G (2000). "Is the optimal dose of angiotensin-converting enzyme inhibitors in patients with congestive heart failure definitely established?". Journal of the American College of Cardiology. 36 (7): 2096–7. PMID 11127446. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)

[pmid8298418-36] "Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration". BMJ (Clinical Research Ed.). 308 (6921): 81–106. 1994. PMC 2539220. PMID 8298418. Retrieved 2011-04-22. Unknown parameter |month= ignored (help)

[Hunt-37] 37.0 ^37.1 ^37.2 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202

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[2]

[3]

[4]

[5]

[6]

[7]

[8]

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[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

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[25]

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@@ Line 62: / Line 62: @@
 ===Angiotensin Converting Enzyme Inhibitors===
-Patients with moderate to severe HF or asymptomatic left ventricular dysfunction show a great improvement in survival rate with the usage of [[ACE inhibitors]].<ref name="pmid1463530">{{cite journal |author= |title=Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigattors |journal=[[The New England Journal of Medicine]] |volume=327 |issue=10 |pages=685–91 |year=1992 |month=September |pmid=1463530 |doi=10.1056/NEJM199209033271003 |url=http://dx.doi.org/10.1056/NEJM199209033271003 |accessdate=2011-04-22}}</ref> ACE inhibitors enhance the action of kinins and augment [[kinin]]-mediated [[prostaglandin]] production, so the effect of [[ACEI]]s cannot be solely explained by the suppression of [[AngiotensinII]] production, moreover it’s been proven that ACEIs modify cardiac remodeling more favorably than [[ARB]]s in experimental models of HF.<ref name="pmid11333991">{{cite journal |author=Exner DV, Dries DL, Domanski MJ, Cohn JN |title=Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction |journal=[[The New England Journal of Medicine]] |volume=344 |issue=18 |pages=1351–7 |year=2001 |month=May |pmid=11333991 |doi=10.1056/NEJM200105033441802 |url=http://dx.doi.org/10.1056/NEJM200105033441802 |accessdate=2011-04-22}}</ref>
+Patients with moderate to severe HF or asymptomatic left ventricular dysfunction show a great improvement in survival rate with the usage of [[ACE inhibitors]].<ref name="pmid1463530">{{cite journal |author= |title=Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigattors |journal=[[The New England Journal of Medicine]] |volume=327 |issue=10 |pages=685–91 |year=1992 |month=September |pmid=1463530 |doi=10.1056/NEJM199209033271003 |url=http://dx.doi.org/10.1056/NEJM199209033271003 |accessdate=2011-04-22}}</ref> ACE inhibitors enhance the action of [[kinins]] and augment [[kinin]]-mediated [[prostaglandin]] production, so the effect of [[ACEI]]s cannot be solely explained by the suppression of [[Angiotensin II]] production.  Furthermore, it has been proven that ACEIs modify cardiac remodeling more favorably than [[ARB]]s in experimental models of HF.<ref name="pmid11333991">{{cite journal |author=Exner DV, Dries DL, Domanski MJ, Cohn JN |title=Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction |journal=[[The New England Journal of Medicine]] |volume=344 |issue=18 |pages=1351–7 |year=2001 |month=May |pmid=11333991 |doi=10.1056/NEJM200105033441802 |url=http://dx.doi.org/10.1056/NEJM200105033441802 |accessdate=2011-04-22}}</ref>  Several studies indicates that [[ACEI]]s can alleviate symptoms,<ref name="pmid10496190">{{cite journal |author=Carson P, Ziesche S, Johnson G, Cohn JN |title=Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group |journal=[[Journal of Cardiac Failure]] |volume=5 |issue=3 |pages=178–87 |year=1999 |month=September |pmid=10496190 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1071916499000196 |accessdate=2011-04-22}}</ref> improve clinical status and sense of well being in patients with HF.
-Several studies indicates that [[ACEI]]s can alleviate symptoms,<ref name="pmid10496190">{{cite journal |author=Carson P, Ziesche S, Johnson G, Cohn JN |title=Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group |journal=[[Journal of Cardiac Failure]] |volume=5 |issue=3 |pages=178–87 |year=1999 |month=September |pmid=10496190 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1071916499000196 |accessdate=2011-04-22}}</ref> improve clinical status and sense of well being of patients with HF.
-Another important aspect of [[ACEI]]s therapy is the reduction of mortality and hospitalization in such patients.<ref name="pmid7654275">{{cite journal |author=Garg R, Yusuf S |title=Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials |journal=[[JAMA : the Journal of the American Medical Association]] |volume=273 |issue=18 |pages=1450–6 |year=1995 |month=May |pmid=7654275 |doi= |url= |accessdate=2011-04-22}}</ref> These benefits were noticed in patients with mild, moderate or even severe symptoms of HF, with or without [[CAD]].
+Another important aspect of [[ACEI]]s therapy is the reduction of mortality and hospitalization in such patients.<ref name="pmid7654275">{{cite journal |author=Garg R, Yusuf S |title=Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials |journal=[[JAMA : the Journal of the American Medical Association]] |volume=273 |issue=18 |pages=1450–6 |year=1995 |month=May |pmid=7654275 |doi= |url= |accessdate=2011-04-22}}</ref> These benefits were noticed in patients with mild, moderate or even severe symptoms of HF, with or without [[CAD]].  In general ACEIs should be used together with  a [[beta blocker]] and should not be used without [[diuretics]] in patients with a current or recent history of fluid retention, because of the important role of [[diuretics]] in maintaining sodium balance and preventing the development of peripheral and [[pulmonary edema]].<ref name="pmid2888942">{{cite journal |author=Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC |title=Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure |journal=[[Lancet]] |volume=2 |issue=8561 |pages=709–11 |year=1987 |month=September |pmid=2888942 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)91074-9 |accessdate=2011-04-22}}</ref>
-In general ACEIs should be used together with  a [[beta blocker]] and should not be used without [[diuretics]] in patients with a current or recent history of fluid retention, because of the important role of [[diuretics]] in maintaining sodium balance and preventing the development of peripheral and [[pulmonary edema]].<ref name="pmid2888942">{{cite journal |author=Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC |title=Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure |journal=[[Lancet]] |volume=2 |issue=8561 |pages=709–11 |year=1987 |month=September |pmid=2888942 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)91074-9 |accessdate=2011-04-22}}</ref>
+For the reasons mentioned above, [[ACEI]] therapy should be started in asymptomatic or symptomatic patients with HF.  The beginning therapy should be a low dose ( eg, 2.5 mg of [[enalapril]] twice a day, 6.25 mg of [[captopril]] three time a day or 5 mg of lisinopril once a day).  The dose should be gradually increased in one to two week if the initial therapy is tolerated and try to target a dose of 20 mg of [[enalapril]] twice a day, or 50 mg of [[captopril]] three times a day or up to 40 mg of [[lisinopril]] a day.<ref name="pmid10587334">{{cite journal |author=Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, Rydén L, Thygesen K, Uretsky BF |title=Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group |journal=[[Circulation]] |volume=100 |issue=23 |pages=2312–8 |year=1999 |month=December |pmid=10587334 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10587334 |accessdate=2011-04-22}}</ref> Plasma potassium and renal function should be assessed one to two weeks after starting or changing a dose and periodically thereafter.  Physicians should attempt to target certain doses which have been proved to reduce the risk of cardiovascular events.  If these target doses of ACEIs cannot be used or poorly tolerated than intermediate doses should be implemented. <ref name="pmid11127446">{{cite journal |author=Delahaye F, de Gevigney G |title=Is the optimal dose of angiotensin-converting enzyme inhibitors in patients with congestive heart failure definitely established? |journal=[[Journal of the American College of Cardiology]] |volume=36 |issue=7 |pages=2096–7 |year=2000 |month=December |pmid=11127446 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)01026-3 |accessdate=2011-04-22}}</ref>
-For the reasons mentioned above, [[ACEI]] therapy should be started in asymptomatic or symptomatic patients with HF. The beginning therapy should be a low dose ( eg, 2.5 mg of [[enalapril]] twice a day, 6.25mg of [[captopril]] three time a day or 5 mg of lisinopril once a day). The dose should be gradually increased in one to two week if the initial therapy is tolerated and try to target a dose of 20 mg of [[enalapril]] twice a day, or 50 mg of [[captopril]] three times a day or up to 40 mg of [[lisinopril]] a day.<ref name="pmid10587334">{{cite journal |author=Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, Rydén L, Thygesen K, Uretsky BF |title=Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group |journal=[[Circulation]] |volume=100 |issue=23 |pages=2312–8 |year=1999 |month=December |pmid=10587334 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10587334 |accessdate=2011-04-22}}</ref> Plasma potassium and renal function should be assessed one to two weeks after starting or changing a dose and periodically thereafter.
+[[NSAID]]s should be avoided since they may cause an increase in adverse effects of [[ACEI]]s in patients with HF and a decrease in the favorable effect of [[ACEI]]s therapy.<ref name="pmid2888942">{{cite journal |author=Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC |title=Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure |journal=[[Lancet]] |volume=2 |issue=8561 |pages=709–11 |year=1987 |month=September |pmid=2888942 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)91074-9 |accessdate=2011-04-22}}</ref> Some evidence suggests that [[aspirin]] may inhibit the acute hemodynamic benefits of [[ACEI]]s.<ref name="pmid8298418">{{cite journal |author= |title=Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration |journal=[[BMJ (Clinical Research Ed.)]] |volume=308 |issue=6921 |pages=81–106 |year=1994 |month=January |pmid=8298418 |pmc=2539220 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=8298418 |accessdate=2011-04-22}}</ref>  If the patient has a know history of coronary artery disease([[CAD]]) then use of [[ASA]] along with [[ACEI]]s is recommended.  However, but in patients with no history of [[CAD]], there is no evidence to support the use of [[aspirin]].  There may be an important interaction between [[aspirin]] and [[ACEIs]] but there is a lot of controversy regarding this point and it needs further study.
-Physicians should attempt to target certain doses which have been proved to reduce the risk of cardiovascular events. If these target doses of ACEIs cannot be used or poorly tolerated than intermediate doses should be implemented in therapy. <ref name="pmid11127446">{{cite journal |author=Delahaye F, de Gevigney G |title=Is the optimal dose of angiotensin-converting enzyme inhibitors in patients with congestive heart failure definitely established? |journal=[[Journal of the American College of Cardiology]] |volume=36 |issue=7 |pages=2096–7 |year=2000 |month=December |pmid=11127446 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)01026-3 |accessdate=2011-04-22}}</ref>
-[[NSAID]]s should be avoided since they may cause an increase in adverse effects of [[ACEI]]s in patients with HF and a decrease in the favorable effect of [[ACEI]]s therapy.<ref name="pmid2888942">{{cite journal |author=Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC |title=Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure |journal=[[Lancet]] |volume=2 |issue=8561 |pages=709–11 |year=1987 |month=September |pmid=2888942 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)91074-9 |accessdate=2011-04-22}}</ref> Some evidence suggests that [[aspirin]] may inhibit the acute hemodynamic effect of [[ACEI]]s.<ref name="pmid8298418">{{cite journal |author= |title=Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration |journal=[[BMJ (Clinical Research Ed.)]] |volume=308 |issue=6921 |pages=81–106 |year=1994 |month=January |pmid=8298418 |pmc=2539220 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=8298418 |accessdate=2011-04-22}}</ref> If the patient has a know history of coronary artery disease([[CAD]]) than it is advised to use [[ASA]] with [[ACEI]]s, but in patients with no history of [[CAD]], there is no evidence for using [[aspirin]]. There may be an important interaction between [[ASPIRIN]] and [[ACEIs]] but there is a lot of controversy regarding this point and it needs further study.
 ==Overview of Treatment of Patients With Current or Prior Symptoms of Heart Failure (Stage C)==

Congestive heart failure treatment of patients with current or prior symptoms of heart failure (Stage C): Difference between revisions

Revision as of 03:09, 2 November 2011

Contents

Overview

Drugs that should be avoided or used with caution in patients with HF

Pharmacological Therapy of HF

Diuretics

Angiotensin Converting Enzyme Inhibitors

Overview of Treatment of Patients With Current or Prior Symptoms of Heart Failure (Stage C)

ACC / AHA Guidelines- Patients with Reduced LVEF (DO NOT EDIT) ^[37]

Class I

Class IIa

Class IIb

Class III

ACC / AHA Guidelines- Patients with HF and Normal LVEF (DO NOT EDIT) ^[37]

Class I

Class IIa

Class IIb

See Also

Sources

References

Navigation menu

Congestive heart failure treatment of patients with current or prior symptoms of heart failure (Stage C): Difference between revisions

Revision as of 03:09, 2 November 2011

Overview

Drugs that should be avoided or used with caution in patients with HF

Pharmacological Therapy of HF

Diuretics

Angiotensin Converting Enzyme Inhibitors

Overview of Treatment of Patients With Current or Prior Symptoms of Heart Failure (Stage C)

ACC / AHA Guidelines- Patients with Reduced LVEF (DO NOT EDIT) [37]

Class I

Class IIa

Class IIb

Class III

ACC / AHA Guidelines- Patients with HF and Normal LVEF (DO NOT EDIT) [37]

Class I

Class IIa

Class IIb

See Also

Sources

References

Navigation menu

ACC / AHA Guidelines- Patients with Reduced LVEF (DO NOT EDIT) ^[37]

ACC / AHA Guidelines- Patients with HF and Normal LVEF (DO NOT EDIT) ^[37]