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Professor and Vice Chair, Department of Pharmacy Practice, University of Kansas Medical Center, Kansas City, KS
Associate Professor of Pharmacy Practice, Long Island University, Brooklyn, NY; Clinical Pharmacy Specialist in Cardiology, Mount Sinai Medical Center, New York, NY
Associate Professor of Pharmacy and Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA
Assistant Professor, Department of Pharmacy Practice, College of Health Professions and Biomedical Sciences, The University of Montana, Missoula, MT
Assistant Professor, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
Professor of Clinical Pharmacy, Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, PA
Professor, Pharmacotherapy and Internal Medicine; Associate Dean, Academic Affairs, College of Pharmacy, University of Utah, Salt Lake City, UT
Reprints: Dr. Howard, Department of Pharmacy, University of Kansas Medical Center, 3901 Rainbow Blvd., Mailstop 4047, Kansas City, KS 66160-7231, fax 913/588-2355, phoward{at}kumc.edu
OBJECTIVE: To review and discuss key aspects of the drug therapy recommendations in the American College of Cardiology (ACC)/American Heart Association (AHA) 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure (HF) in the Adult.
DATA SOURCES: Data were obtained from the ACC/AHA 2005 Guideline Update for Chronic HF. English-language clinical trials, observational studies, and pertinent review articles evaluating the pharmacotherapy of chronic HF were identified, based on MEDLINE searches through January 2006.
STUDY SELECTION: Articles presenting information that impacts the evidence base for recommendations regarding the use of various drug therapies in patients with chronic HF were evaluated.
DATA SYNTHESIS: The ACC/AHA 2005 Guideline Update for HF provides revised, evidence-based recommendations for the treatment of chronic HF. The new guidelines are based on a staging system that recognizes both the development and progression of HF. Recommendations are provided for 2 stages of patients (A and B) who do not yet have clinical HF but are clearly at risk and 2 stages (C and D) that include patients with symptomatic HF. The guidelines continue to emphasize the important role of neurohormonal blockade with angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, ß-adrenergic blockers, and aldosterone antagonists. Based on recent trials, updated recommendations address the roles of combination therapy and the selective addition of hydralazine and isosorbide dinitrate. Along with specific drug recommendations, information on the practical use of various drugs is provided. Although the guidelines primarily focus on HF due to systolic dysfunction, general recommendations are also provided for patients with preserved systolic function.
CONCLUSIONS: The ACC/AHA 2005 Guideline Update provides evidence-based recommendations for healthcare professionals involved in the care of adults with chronic HF. Recent clinical trial findings have further clarified the evolving role of neurohormonal-blocking drugs in the prevention and treatment of HF.
Key Words: chronic heart failure, practice guidelines
Published Online, August 8, 2006. www.theannals.com, DOI 10.1345/aph.1H059
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