Several medications used in treatment of heart failure

Heart failure is a serious condition in which the heart doesn't pump enough blood throughout the body. It may be caused by several different diseases that damage or overwork the heart muscle; the leading causes include coronary artery disease, high blood pressure and diabetes.

Various drugs used to treat heart failure include:

In general, heart failure patients with left ventricular problems or a history of myocardial infarction should take both an ACE inhibitor and a beta-blocker, and usually a diuretic as well. Angiotensin receptor blockers are recommended for patients who cannot tolerate ACE inhibitors and are sometimes also used as first-line therapy. They also are used for patients who have persistent symptoms and already are treated with an ACE inhibitor plus a beta-blocker.

Most experts believe all ACE inhibitors are effective for treatment of heart failure. Controlled trials have shown that use of bisoprolol, Coreg, or Toprol-XL is consistently associated with a 30% to 40% reduction in the combined end point of mortality and hospitalizations in patients with moderate to severe heart failure.

"There is no published evidence supporting the effectiveness of other beta-blockers for treatment of heart failure," says Mark Abramowicz, MD, editor of The Medical Letter on Drugs and Therapeutics, a non-profit newsletter that critically appraises drugs. "Most experts do not believe that all beta-blockers are equally effective for treatment of heart failure."

ARBS USED FOR HEART FAILURE

Long-term therapy with ARBs reduces the risk of death and other cardiovascular events in patients with heart failure; the results are comparable to ACE inhibitors. The FDA has approved two ARBs for treatment of heart failure: Atacand and Diovan. "Most experts believe that all ARBs could be effective for this indication," says Dr. Abramowicz. "However, the effective dose for other ARBs has not been established by large-scale trials."

Close communication with specially trained nurses can substantially aid heart failure patients and help them control the disease. Alere Medical Inc., of Reno, Nev., offers disease management services for chronic conditions, including heart failure. Under its program, high-risk heart failure patients receive an interactive bathroom scale that can transmit personal data via a phone line. Nurses review the patient's data daily, and when there are signs of trouble, the nurse first telephones the patient to verify the information, and then notifies the doctor via fax.

At their initial assessment and at every subsequent contact, patients are asked about their medications.