Chapter 47. Management of Overt Heart Failure

  1. Salim Yusuf DPhil, FRCPC, FRSC Research Chair Professor of Medicine Director Vice President Research3,4,5,
  2. John A Cairns MD, FRCPC Professor of Medicine Former Dean6,
  3. A John Camm MD British Heart Foundation Professor Head of Cardiac7,
  4. Ernest L Fallen MD, FRCPC Professor Emeritus8 and
  5. Bernard J Gersh MB, ChB, DPhil Consultant Professor of Medicine9
  1. Paul J Hauptman MD Professor of Internal Medicine1 and
  2. Karl Swedberg MD, PhD Head Professor of Medicine2

Published Online: 21 MAY 2010

DOI: 10.1002/9781444309768.ch47

Evidence-Based Cardiology, Third Edition

Evidence-Based Cardiology, Third Edition

How to Cite

Hauptman, P. J. and Swedberg, K. (2009) Management of Overt Heart Failure, in Evidence-Based Cardiology, Third Edition (eds S. Yusuf, J. A. Cairns, A. J. Camm, E. L. Fallen and B. J. Gersh), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444309768.ch47

Editor Information

  1. 3

    McMaster University, Canada

  2. 4

    Population Health Research Institute, McMaster University, Hamilton Health Sciences, Canada

  3. 5

    Hamilton Health Sciences, Hamilton, Ontario, Canada

  4. 6

    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

  5. 7

    St George's University of London, London, UK

  6. 8

    McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

  7. 9

    Mayo Clinic College of Medicine, Rochester, MN, USA

Author Information

  1. 1

    Saint Louis University School of Medicine, St. Louis, MO, USA

  2. 2

    Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Göteborg, Sweden

Publication History

  1. Published Online: 21 MAY 2010
  2. Published Print: 13 NOV 2009

ISBN Information

Print ISBN: 9781405159258

Online ISBN: 9781444309768



  • Neurohormonal and hemodynamic effects of loop diuretics;
  • Alternative to diuretic therapy - ultrafiltration;
  • Effects of long-term vasodilator therapy;
  • Drugs affecting the renin-angiotensin system;
  • Angiotensin II receptor (AT1) antagonists;
  • Non-digitalis inotropic drugs: short-term therapy but no long-term role;
  • Other inotropic agents: a history marked by failure;
  • Hemodynamic and neurohormonal effects;
  • Implantable cardioverter defibrillators and biventricular pacing (cardiac resynchronization therapy);
  • Heart failure with preserved left ventricular function


Heart failure (HF) is a progressive complex disorder and one of society's most considerable health-economic burdens. In recent decades, our understanding of the pathophysiology of HF has increased greatly. This is supported by epidemiological data drawn from a variety of sources, indicating the sizeable prevalence of HF and identifying causal factors and individuals at risk. From this we may then gauge an estimate of the community burden and develop strategies to prevent future disease or at least slow progression. In this chapter we will outline the clinical epidemiology and aetiology of HF, an understanding of which is essential to develop effective preventative strategies. The progressive nature of HF has generated an increased interest in its early, asymptomatic stages. This is particularly relevant given the availability of evidence-based strategies, which may delay progression to overt disease. We will review and appraise the best currently available clinical evidence.