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Evidence-based drug therapy for chronic heart failure

F Zannad*

Département des Maladies Cardio Vasculaires and Centre d'Investigations Cliniques INSERM-CHU, Université Henri Poincaré, Nancy, France

* Correspondence: Faiez Zannad, CIC INSERM-CHU, Hôpital Jeanne d'Arc, 54200 Dommartin Les Toul, Nancy, France.

Abstract

Evidence-based medicine requires that clinical benefits should be evaluated by ‘hard’ end-points (i.e. morbidity and mortality). ‘Soft’ intermediate end-points such as haemodynamic improvement are not always associated with improvements in quality of life or survival. Changes in clinical practice should be based on statistically significant effects on primary end-points, and not on subgroup analyses. Angiotensin-converting enzyme (ACE) inhibitors are of demonstrated benefit in all forms of congestive heart failure (CHF) with systolic dysfunction, when used at optimal doses. Beta-blockers confer additional quality of life and survival benefits. Spironolactone may be added in patients with severe CHF. In patients who are intolerant of ACE inhibitors, angiotensin II receptor blockers may be useful as a substitute. Despite the overwhelming data available, evidence-based recommendations for drug therapy are not widely implemented in CHF. Education and implementation programmes should be designed with the objective of combating ignorance, incredulity and inaction.

Key Words: Clinical trials • drug therapy • guidelines • heart failure


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