Continuing Progress in the Treatment of Severe Congestive Heart Failure

Despite advances in its medical management, severe congestive heart failure remains associated with substantial morbidity and mortality. Prognosis has improved only slightly during the past decade among unselected community patients with congestive heart failure.1 It appears that the benefits documented in large randomized clinical trials have not been fully realized. Two articles in this issue of THE JOURNAL describe encouraging findings regarding 2 relatively novel therapeutic approaches for congestive heart failure:-blockers and cardiac resynchronization therapy. During the last 5 years, randomized clinical trials have consistently demonstrated that several-blocking agents (bisoprolol, carvedilol, and metoprolol) substantially reduce morbidity and mortality in a wide spectrum of patients with heart failure and depressed left ventricular systolic function.2 Thus, current practice guidelines recommend-blockers as first-line therapy in all patients with symptomatic left ventricular systolic dysfunction.3-Blocker utilization, however, is not yet widespread, especially among primary care physicians. A recent European survey showed that despite physicians ' awareness of the benefits of-blocker therapy, only 34 % of a representative sample of patients with heart failure were being treated with these agents, and only 20 % with angiotensin-converting enzyme (ACE) inhibitors and-blockers combined.4-Blocker use was even lower 20 % among patients with documented left ventricular systolic dysfunction.4