© 2005 European Society of Cardiology
Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: Putting guidelines into practice
a Department of Cardiology Western Infirmary, Glasgow, G12 8QQ, UK
b Hopital Beaujon Clichy, France
c Franz-Volhard-Klinik Berlin, Germany
d VA Hospital, Dallas, USA
e University Hospital, Malmo, Sweden
f Department of Primary Care and General Practice Birmingham, UK
g Departments of Epidemiology and Preventive Medicine and Medicine Monash University/Alfred Hospital Melbourne Victoria, Australia
h Research Centre, ANMCO, Florence, Italy
i Division of Cardiology McMaster University, Hamilton, Canada
j Case Western Reserve University Cleveland, Ohio, USA
k University General Hospital Barcelona, Spain
l Department of Medicine, Sahlgrenska University Hospital/Östra Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden
* Corresponding author. Tel.: +44 141 211 1838; fax: +44 141 211 2252. E-mail address: j.mcmurray{at}bio.gla.ac.uk
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Abstract |
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Surveys of prescribing patterns in both hospitals and primary care have usually shown delays in translating the evidence from clinical trials of pharmacological agents into clinical practice, thereby denying patients with heart failure (HF) the benefits of drug treatments proven to improve well-being and prolong life. This may be due to unfamiliarity with the evidence-base for these therapies, the clinical guidelines recommending the use of these treatments or both, as well as concerns regarding adverse events. ACE inhibitors have long been the cornerstone of therapy for systolic HF irrespective of aetiology. Recent trials have now shown that treatment with beta-blockers, aldosterone antagonists and angiotensin receptor blockers also leads to substantial improvements in outcome. In order to accelerate the safe uptake of these treatments and to ensure that all eligible patients receive the most appropriate medications, a clear and concise set of clinical recommendations has been prepared by a group of clinicians with practical expertise in the management of HF. The objective of these recommendations is to provide practical guidance for non-specialists, in order to increase the use of evidenced based therapy for HF. These practical recommendations are meant to serve as a supplement to, rather than replacement of, existing HF guidelines.
Key Words: ACE inhibitors • Aldosterone antagonists • Angiotensin receptor blockers • Beta-blockers • Clinical recommendations • Digoxin • Eplerenone • Heart failure • Hydralazine • Isosorbide dinitrate • Pharmacology • Spironolactone • Treatment
Received April 18, 2005; Revised July 5, 2005; Accepted July 6, 2005
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