Current implementation of proven therapy in heart failure

Heart failure is an increasingly common cause of death and morbidity, that imposes substantial demands on healthcare resources. Treatment has traditionally focused on symptomatic relief, but recognition that neurohormonal blockade with angiotensinconverting-enzyme (ACE) inhibitors or β-blockers improves prognosis has led to these agents becoming the current standard of care, although future guidelines are likely to recommend a more prominent role for AT1-receptor blockers and aldosterone antagonists. However, despite the existence of several sets of evidence-based heartfailure management guidelines, ACE inhibitors and β-blockers remain under-used in clinical practice. Two large European surveys, the EuroHeart Failure survey and the IMPROVEMENT survey, suggest that ACE inhibitors are used in only about 60% of patients, and that even when treatment is given the doses used are often suboptimal. There are a number of potential reasons for this under-treatment, including a continuing focus by both physicians and patients on symptomatic relief rather than prognosis, and physician concerns about adverse events or the complexity of therapy. Physician education is needed to overcome these barriers to the implementation of heart-failure management guidelines.