VARIABLE EFFICACY: Prognosis in patients with chronic
heart failure remains poor. Certain drugs can lower mortality and improve quality of life. DRUGS WITH PROVEN EFFICACY: Converting
enzyme inhibitors (CEI) have proven efficacy and should be used in all stages of
heart failure outside
contraindications. High-dose regimens are recommended when tolerated. Certain beta-blockers have also been added to the list of effective drugs for
heart failure. Positive data have been reported for metroprolol,
bisoprolol and
carvedilol. Improved function has been demonstrated only with
carvedilol allowing a clear reduction in mortality; it is currently indicated in combination with CEI and
diuretics for patients with symptomatic
heart failure. DRUGS WITH INSUFFICIENTLY PROVEN EFFICACY: Certain drugs which have been used for many years can improve heart function but data clearly proving lower mortality are lacking. These include
diuretics and
nitrate derivatives for symptomatic patients and digitalics which are useful not only for patients with complete
arrhythmia due to
atrial fibrillation but also for symptomatic patients with sinus rhythm. According to preliminary studies,
aldosterone antagonists appear to have a positive effect on mortality due to
heart failure. DRUGS WITH LIMITED INDICATIONS: Other drugs have been found to have no effect on mortality.
Amiodarone,
amlodipine and
felodipine can thus be used for patients with associated diseases. Finally
anticoagulant therapy should be reserved for patients with
atrial fibrillation or a history of
thromboembolism.