chemamr
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Which are the drugs that have proven to improve mortality in congestive heart failure? 
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| mesh
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carvedilol
ACE inhibitors...?
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| chemamr
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there are 3 groups, at least
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| p53
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No, there are only 2 groups, which improve mortality in congestive heart failure: A-CE inhibitors and Beta-blockers.
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| chemamr
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no, they are 3. Effectively ACEI, beta blockers and SPIRONOLACTONE (K-sparing diuretic) 
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| p53
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I don't think so. At least Katzung's 'basic and clinical pharmacology', 2004, mentions only my 2, if I can remember correctly. What is your source of info?
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| chemamr
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CMDT (Tierney) and even it mentions a recent trial named RALES that showed a 29% reduction in mortality. Itīs even useful reducing mortality in class IV of heart failure.
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| chemamr
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the last message was about Spironolactone
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| p53
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OK. Thank you for new info.
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| chemamr
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youīre welcome.
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| mdwannabe
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ARB's have ben shown to reduce morbidity by reducing fibrosis in failing heart, in fact new reccomendation is to start it much earlier than class IV failure....may be even on the par with Beta-blockers and ACEI.
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| chemamr
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Iīm sorry, what is ARBīS ?????
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| Moctopod
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Angiotension receptor blockers.
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| chemamr
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thank you
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| kingsofke
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Recent trials show even benefit of Amlodipine (more vascular selective CCB) atleast what Trevor says in Kaplan lectures.
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| medmanparadise
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You want to attempt to do 3 things in heart failure:
1. Decrease Preload: diuretics (spironolactone reduces mortality only in conjuction with an ACE-I!!!!), ACE-I's (also slows remodeling which reduces mortality), ARB's, and vasodilators
2. Decrease Afterload: ACE-I's, ARB's, vasodilators
3. Increase Contractility: digitalis (no improvement in survival only symptomology.)
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| dr_brown
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OK speaking from beta blocker point of view there are three main ones used in heart failure. Carvedolol, bisoprolol and nebivolol.
All three have outcome data but only nebivolol is shown to reduce a combined end point of mortality and cardiovascular rehospitalization.
So if you are looking at quality of life, nebivolol is the only one proven.
The aim of heart failurte treatment is to improve symptoms and quality of life.
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