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New approaches in the management of patients with chronic congestive heart failure.

The cost of caring for a growing number of patients with congestive heart failure is a staggering economic burden. Fortunately, an increasing number of evidence-based guidelines have been developed which, if implemented, have the potential to save lives and money. In addition, there are newer understandings about the potential of current therapies, both medical and surgical, to prevent the progression of disease. The foundation of diuretics, ACE inhibitors and beta-blockers serves to improve symptoms, decrease hospitalizations and improve survival. The roles of angiotensin receptor antagonists and cytokine antagonists are currently being clarified. The potential for myocardial recovery during left ventricular assist implantation has paved the way for some exciting surgical procedures. The challenge in the future will be to develop an approach to the patient with heart failure which takes advantage of this new knowledge while avoiding a bewildering array of costly drugs which may not all be necessary at all stages of the disease.