Key result
Coronary heart disease drives ~64% of chronic heart failure cases across multicenter clinical trials.
Why the study?
Although there is a common misconception that chronic heart failure treatment is uniform regardless of etiology, underlying diseases such as coronary heart disease distinctly shape the clinical course, therapy, and prognosis of heart failure.
Does the ischemic etiology of chronic heart failure alter the effectiveness of standard pharmacological therapies on mortality and morbidity compared to non-ischemic etiologies?
Does the ischemic etiology of chronic heart failure alter the effectiveness of standard pharmacological therapies on mortality and morbidity compared to non-ischemic etiologies?
This narrative review highlights that chronic heart failure secondary to ischemic heart disease has distinct pathophysiological mechanisms (including stunning, hibernation, and endothelial dysfunction) and often responds less favorably to standard heart failure pharmacotherapies than non-ischemic cardiomyopathy, necessitating targeted vascular and lipid-lowering strategies.
Coronary etiology predominates in heart failure with established therapies; leaves open whether cause-specific strategies improve outcomes beyond current evidence.
One of the main postulates of medicine is that optimal treatment of a disease is impossible without knowing its cause. However, this principle is difficult to apply to chronic heart failure (CHF). This is due to the fact that, although the diseases that lead to the development of CHF are numerous and varied, the final outcome is the same for all - decompensation of cardiac activity. There is an illusion that the cause of CHF is no longer important and the treatment is the same in all cases: be it coronary heart disease (CHD), dilated cardiomyopathy (DCM) or hypertensive heart disease. However, this is not the case. Any disease underlying CHF has its own characteristics that leave an imprint on the course of heart failure, its therapy and prognosis. This is especially true for such a common and serious disease as coronary heart disease.
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Madjidova et al. (2026) conducted a review in Chronic heart failure due to ischemic heart disease (coronary heart disease). Pharmacotherapy for chronic heart failure (digoxin, ACE inhibitors, beta-blockers, amiodarone, calcium antagonists, statins) vs. Non-ischemic heart failure (e.g., dilated cardiomyopathy) or placebo in reviewed trials was evaluated. Coronary heart disease accounts for an average of 64% of chronic heart failure cases in multicenter trials, where ACE inhibitors and beta-blockers reduce mortality by 23% and 34-65%, respectively.
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