PPRNet Practice Guidelines
Heart Failure
ACE
inhibitor (or ARB) and ß-blocker prescribed for patients with heart failure
Multiple outcome trials have
found that angiotensin converting enzyme inhibitors (ACEI) reduce mortality,
hospital admission for heart failure
(HF), and ischemic events in people with HF.
Relative benefits are similar in different groups of people, but absolute
benefits are greater in people with severe HF. Several
trials involving patients with HF have shown that angiotensin-receptor
antagonists (ARBs) have efficacy similar to that of ACE inhibitors
are are appropriate alternatives for patients who cannot tolerate ACEIs due to
cough.
Strong
evidence from systematic reviews also shows that adding ß blockers to standard
treatment with ACEIs in people with moderate and severe HF reduces the rate of hospital admission or death. The
beneficial effects of these drugs have been demonstrated in trials
involving patients with HF
from various causes and of all stages. These effects include improvements
in survival, morbidity, ejection fraction, remodeling, quality of
life, the rate of hospitalization, and the incidence of sudden death.
ß-blockers should be used in all patients in stable condition
without substantial fluid retention and without recent exacerbations
of HF. There are a few
populations of patients in whom ß-blockers should not be used or
should be used only with extreme caution. Such patients include those
with reactive airway disease, those with diabetes in association with
frequent episodes of hypoglycemia, and those with bradyarrhythmias or
heart
block who do not have a pacemaker.
Additional
resources
