Despite the significant advances in drug therapy for congestive heart failure over the past 20 years, many exciting developments are under active study. New classes of medications are being tested in clinical trials, including the calcium sensitizing agents, vasopeptidase inhibitors, and natriuretic peptides. As was the case with the ACE inhibitors and beta-blockers, the potential use of these drugs is based on theoretical considerations that have resulted from an increased understanding of the processes both underlying and resulting from heart failure. Additionally, gene therapy that is targeted toward certain genes thought to contribute to heart failure is being tested.
These developments have justified an unprecedented optimism in the treatment of congestive heart failure. The majority of patients, with appropriate lifestyle measures and medical regimens, can maintain active, fulfilling lifestyles. The range of treatment options has been significantly strengthened by drugs such as the ACE inhibitors and beta-blockers. In the future, we will surely see the addition of many more and equally potent interventions.
Addressing potentially reversible factors
Depending on the underlying cause of congestive heart failure, potentially reversible factors should be explored. For example, in certain patients whose congestive heart failure is caused by inadequate blood flow to the heart muscle, restoration of the blood flow through coronary artery surgery or catheter procedures (angioplasty, intracoronary stenting) may be considered. Congestive heart failure that is due to severe disease of the valves may be alleviated in appropriate patients by valve surgery. When congestive heart failure is caused by chronic, uncontrolled high blood pressure (hypertension), aggressive blood pressure control will often improve the condition. Likewise, heart muscle weakness that is due to longstanding, severe alcohol abuse can improve significantly with abstinence from drinking. Congestive heart failure that is caused by other disease states may be similarly partially or completely reversible by appropriate measures.
