Congestive Heart Failure or CHF
Congestive Heart Failure or CHF is a medical condition that affects 4.8 million individuals in the USA. And, 400,000 to 700,000 new cases are estimated to develop each year -1. The risk of developing CHF increases with age. Aging of the population ensure that the heart failure problem will substantially worsen in the next decade.
Experts have projected a 2- to 3-fold increase in prevalence -2. Advance heart failure remains one of the most disabling and lethal medical conditions3.
Heart failure is often the final end condition for many heart conditions that results in left ventricular dysfunction with or without symptoms4. The most common causes are blockage of blood vessels, a diseased heart muscle, long-standing (untreated) high blood pressure, abnormal heart rhythms, heart valve problems, congenital heart disease, and toxic substances such as prolonged alcohol abuse.
There may not be any symptoms noticeable at first. Then, gradually, you may notice shortness of breath noticed on exertion. As the disease worsens, shortness of breath may worsen regardless if you are exerting yourself or just lying down or sleeping! Other symptoms that may occur are fatigue or weakness, swelling in the feet, ankles, and abdomen, swollen or distended neck veins, chronic cough, and weight gain.
Current therapy focuses primarily on blocking the renin-angiotensin-aldosterone system, a major chemical system in the human body, through the blocking of ACE, the enzyme that promotes this system. Numerous clinical studies and practice guidelines recommend the use of ACE inhibitors because they have proven that they improve quality of life and prevent death and provide symptomatic relief 5,6,7. AC E inhibitors include drugs like Vasotec, Prinivil, Zestril, Monopril, and Mavik. Not all ACE inhibitors have been FDA approved for CHF, but most are used regardless.
There are numerous practice guidelines for treating CHF that physicians use such as the American Heart Association, the Heart Failure Society of America, the National Institute of Health, to name just a few and all recommend the use of an ACE inhibitor as first line. Even with all these guidelines, the use of an ACE is low, only 40-60% based on reporting HMOs to NCQA HEDIS guidelines8. HEDIS reports “grades” HMOs on how well they treat certain disease states so John Q. Public has something to back there decision on using as their healthcare provider.
There are some patients that cannot take ACE inhibitors for their CHF such as patients with certain kidney problems. ACE inhibitors can also produce a dry cough but with some patients the benefits are far better than this minor inconvenience. There is a cousin to the ACE inhibitor class called the ARB or Angiotensin Receptor Blockers that does everything the ACE does without the cough. However, ARBs (Cozaar, Diovan, and others) are not FDA approved for CHF yet. Other drugs that can be used in patients that can not benefit from an ACE include beta blockers such as Toprol XL or Coreg, Aldactone, and the combination of Hydralazine and Isosorbide Dinitrate.
If you have CHF, talk to your pharmacist or your doctor about whether you should possibly be on an ACE inhibitor or not. It could be the best thing you can do for your health!
1. American Heart Association. 1998 Heart and Stroke Statisical Update Dallas, TX 1997.
2. Journal Internal Medicine 1995;237:135-41.
3. American Heart Journal 1998;135:S107-12.
4. American Journal of Cardiology 1993;71(Suppl):3C-11.
5. American Journal of Cardiology 1999;83(Suppl):1A-38.
6. Circulation 1995;92:2764-84.
7. European Heart Journal 1997;18:736-53.
8. NCQA HEDIS Report 1999
