Medikamentell behandling av kronisk systolisk hjertesvikt - er det mulighet for forbedring?

Abstract

Abstract

Background: Our goal is to review the current treatment recommendations for chronic heart failure (CHF).

Methods: A Medline/PudMed, Cochrane and Google search (1999-2006) was performed using “betablocker AND heart failure”, “ACE-inhibitor AND heart failure”, “Kjekshus”, “Wikstrand” and other pertinent terms.

Results: Beta-blockade should be prescribed for the majority of patients with heart failure, including those over 65 years. Three types of beta-blocker are proven effective; metoprolol CR/XL, bisoprolol and carvedilol. Data suggests that a beta-blocker should be introduced as early as possible. Accordingly to Willenheimer, the CIBIS III trial demonstrated that bisoprolol could be started first just as safely as an ACE inhibitor. ACE-inhibitors should remain first line treatment instead of AII-blockers. An AII-blocker is a good alternative when ACE-inhibitors are not tolerated. The CORONA trial is being performed to determine whether the addition of a statin is beneficial. The standard treatment-regimen for CHF includes ACE-inhibitors, beta-blockers and diuretics, although the treatment with diuretics is not evidence-based. Digitalis should still be used in CHF-patients with atrial fibrillation. In patients with a normal sinus-rhythm, digitalis does not improve survival. Patients with serious CHF (NYHA-class III-IV) should be treated with aldosteron antagonist, but the effect is not yet clear in patients with mild CHF.

Conclusion: Although the treatment guidelines for CHF are well defined, data suggests that the regimen is not always the one used in clinical practice. For example many clinicians use beta-blockers in smaller doses compared to the clinical trials.