Skip to main content
NCBI home page
Heart logoLink to Heart
. 2005 May;91(Suppl 2):ii24–ii27. doi: 10.1136/hrt.2005.062067

Lessons from the management of chronic heart failure

T McDonagh
PMCID: PMC1876348  PMID: 15831605

Abstract

In seeking to implement evidence based medicine for the patient with heart failure occurring after a myocardial infarction (MI), much can be learnt from the long road to delivery of best care for the patient with chronic heart failure (CHF) caused by left ventricular systolic dysfunction. Both patient groups are part of the same cardiovascular continuum. A mass of evidence has accrued for the beneficial effects of angiotensin converting enzyme inhibitors, ß blockers, and aldosterone antagonists on both morbidity and mortality across a wide spectrum of patient severity. This evidence has informed the development of management guidelines, although registry data showed that uptake of treatments remained low, leading to research focused on how heart failure care could be delivered more effectively. This has resulted in a range of heart failure management programmes, many of which have been shown to reduce hospital admission rates and to improve adherence with treatments. Multidisciplinary heart failure management programmes that span primary and secondary care are now considered a routine "standard" to be aspired to in delivering effective CHF care. Applying such an approach to the care of the post-MI heart failure patient should be equally important.

Full Text

The Full Text of this article is available as a PDF (70.8 KB).

Figure 1.

Figure 1

Open in a new tab

 Most patients who develop heart failure, do so following a myocardial infarction and development of left ventricular dysfunction. CHD, coronary heart disease; LV, left ventricular; MI, myocardial infarction.

Figure 2.

Figure 2

Open in a new tab

 The British Society of Heart Failure blueprint for integrated heart failure services was designed to manage patients admitted with decompensated heart failure or those referred from primary care with prevalent or incident heart failure, but could also include patients with post-MI heart failure. CHF, chronic heart failure: GPwSI, general practitioner with a specialist interest; HF, heart failure; MI, myocardial infarction.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Blue L., Lang E., McMurray J. J., Davie A. P., McDonagh T. A., Murdoch D. R., Petrie M. C., Connolly E., Norrie J., Round C. E. Randomised controlled trial of specialist nurse intervention in heart failure. BMJ. 2001 Sep 29;323(7315):715–718. doi: 10.1136/bmj.323.7315.715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Butler Javed, Arbogast Patrick G., BeLue Rhonda, Daugherty James, Jain Manoj K., Ray Wayne A., Griffin Marie R. Outpatient adherence to beta-blocker therapy after acute myocardial infarction. J Am Coll Cardiol. 2002 Nov 6;40(9):1589–1595. doi: 10.1016/s0735-1097(02)02379-3. [DOI] [PubMed] [Google Scholar]
  3. Cleland J. G. F., Cohen-Solal A., Aguilar J. Cosin, Dietz R., Eastaugh J., Follath F., Freemantle N., Gavazzi A., van Gilst W. H., Hobbs F. D. R. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet. 2002 Nov 23;360(9346):1631–1639. doi: 10.1016/s0140-6736(02)11601-1. [DOI] [PubMed] [Google Scholar]
  4. Dargie H. J. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001 May 5;357(9266):1385–1390. doi: 10.1016/s0140-6736(00)04560-8. [DOI] [PubMed] [Google Scholar]
  5. Eagle Kim A., Kline-Rogers Eva, Goodman Shaun G., Gurfinkel Enrique P., Avezum Alvaro, Flather Marcus D., Granger Christopher B., Erickson Steve, White Kami, Steg Philippe Gabriel. Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study. Am J Med. 2004 Jul 15;117(2):73–81. doi: 10.1016/j.amjmed.2003.12.041. [DOI] [PubMed] [Google Scholar]
  6. Fonarow G. C., Gawlinski A., Moughrabi S., Tillisch J. H. Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). Am J Cardiol. 2001 Apr 1;87(7):819–822. doi: 10.1016/s0002-9149(00)01519-8. [DOI] [PubMed] [Google Scholar]
  7. Gattis Wendy A., O'Connor Christopher M., Gallup Dianne S., Hasselblad Vic, Gheorghiade Mihai, IMPACT-HF Investigators and Coordinators Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure: results of the Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy in Heart Failure (IMPACT-HF) trial. J Am Coll Cardiol. 2004 May 5;43(9):1534–1541. doi: 10.1016/j.jacc.2003.12.040. [DOI] [PubMed] [Google Scholar]
  8. Hunt S. A., Baker D. W., Chin M. H., Cinquegrani M. P., Feldman A. M., Francis G. S., Ganiats T. G., Goldstein S., Gregoratos G., Jessup M. L. ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America. Circulation. 2001 Dec 11;104(24):2996–3007. doi: 10.1161/hc4901.102568. [DOI] [PubMed] [Google Scholar]
  9. Køber L., Torp-Pedersen C., Carlsen J. E., Bagger H., Eliasen P., Lyngborg K., Videbaek J., Cole D. S., Auclert L., Pauly N. C. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. N Engl J Med. 1995 Dec 21;333(25):1670–1676. doi: 10.1056/NEJM199512213332503. [DOI] [PubMed] [Google Scholar]
  10. McAlister Finlay A., Stewart Simon, Ferrua Stefania, McMurray John J. J. V. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol. 2004 Aug 18;44(4):810–819. doi: 10.1016/j.jacc.2004.05.055. [DOI] [PubMed] [Google Scholar]
  11. Pfeffer M. A., Braunwald E., Moyé L. A., Basta L., Brown E. J., Jr, Cuddy T. E., Davis B. R., Geltman E. M., Goldman S., Flaker G. C. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992 Sep 3;327(10):669–677. doi: 10.1056/NEJM199209033271001. [DOI] [PubMed] [Google Scholar]
  12. Pitt Bertram, Remme Willem, Zannad Faiez, Neaton James, Martinez Felipe, Roniker Barbara, Bittman Richard, Hurley Steve, Kleiman Jay, Gatlin Marjorie. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003 Mar 31;348(14):1309–1321. doi: 10.1056/NEJMoa030207. [DOI] [PubMed] [Google Scholar]
  13. Rich M. W., Beckham V., Wittenberg C., Leven C. L., Freedland K. E., Carney R. M. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995 Nov 2;333(18):1190–1195. doi: 10.1056/NEJM199511023331806. [DOI] [PubMed] [Google Scholar]
  14. Spencer Frederick A., Meyer Theo E., Gore Joel M., Goldberg Robert J. Heterogeneity in the management and outcomes of patients with acute myocardial infarction complicated by heart failure: the National Registry of Myocardial Infarction. Circulation. 2002 Jun 4;105(22):2605–2610. doi: 10.1161/01.cir.0000017861.00991.2f. [DOI] [PubMed] [Google Scholar]
  15. Stewart S., Marley J. E., Horowitz J. D. Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study. Lancet. 1999 Sep 25;354(9184):1077–1083. doi: 10.1016/s0140-6736(99)03428-5. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES