Clinical management of CHF: Progress through clinical trials

Appropriate management of congestive heart failure (CHF) requires identification and treatment of its underlying causes. Under the broad umbrella of CHF, a series of clinical trials has shown that angiotensin converting enzyme (ACE) inhibitors effectively prolong survival, reduce symptom severity and decrease hospital stays in patients with all degrees of established left ventricular (LV) dysfunction. ACE inhibitors also prevent CHF in patients with asymptomatic LV dysfunction, and reduce mortality as well as the incidence of nonfatal cardiovascular events in patients with asymptomatic LV dysfunction following myocardial infarction (MI). Trials of inotropic drugs have, in many cases, shown an increase in mortality in the treatment arm. Ongoing protocols are underway to further evaluate inotropic drugs, particularly digoxin.