Pharmacotherapy for Systolic Dysfunction: A Review of Randomized Clinical Trials

Using Focus Groups to Identify Barriers to Drug Use in Patients with Congestive Heart Failure

“…␤-blockers, and others, as well as short-term symptomatic treatment with diuretics. 3 Despite irrefutable evidence to support the efficacy of these agents, many eligible patients do not receive them. 4 Furthermore, it is estimated that approximately 50% of patients prescribed lifelong therapies will stop taking them after only 1 year.…”

The effects of acute afterload change on systolic ventricular function in conscious dogs with normal vs. failing hearts

“…By definition, any measure of ventricular intrinsic contractility or contractile performance must be insensitive to changes in ventricular preload and afterload [17]. To be practical in studies of congestive heart failure, measures of contractile performance must also be insensitive to loading conditions because preload and afterload are affected both by congestive heart failure [1–4] and by treatment for heart failure [12,18,19]. The present study demonstrated that the preload recruitable stroke work and end‐systolic pressure–volume relationships are indeed insensitive to afterload changes in both the normal and failing heart.…”

“…This afterload sensitivity has been proposed as a mechanism by which afterload reduction benefits the failing heart [9–11]. Further, afterload reduction has been shown to improve the outcome of patients with congestive heart failure [12]. However, although these data suggest that afterload indeed affects cardiac performance in the failing heart, few data exist to demonstrate whether the failing heart does have an impaired intrinsic contractile reserve and responds to changes in afterload in an inherently different manner from normal hearts.…”

Management of Advanced Heart Failure

“…Dobutamine and milrinone appear to improve functional capacity and symptoms in patients with advanced heart failure, but also decrease survival compared to placebo [29,30]. In the Outcomes of Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (or OPTIME-CHF), the trial investigators randomized 951 patients with exacerbation of chronic CHF not requiring inotropic support to 48-hour intravenous treatment with milrinone or placebo The milrinone group was associated with both a higher incidence of worsening of heart failure, symptomatic hypotension requiring intervention, and new atrial arrhythmias.…”