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PHARMACOLOGICAL TREATMENT OF HEART FAILURE (HF) - page 42 / 48

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syndrome of HF. In many patients, appropriate management of these concomitant illnesses may produce clinical and prognostic benefits that may be as important as the treatment of HF itself. These concomitant conditions include cardiovascular disorders such as hypertension, hyperlipidemia, and diabetes mellitus; coronary artery disease; supraventricular arrhythmias; ventricular arrhythmias and prevention of sudden death; and prevention of thrombotic events. Associated non-cardiovascular disorders include renal insufficiency, pulmonary disease, cancer, and thyroid disease.

The following are the AHA/ACC guidelines for the management of concomitant diseases in patients with HF

Class I recommendations

Control of systolic and diastolic hypertension in patients with HF in accordance with recommended guidelines. (Level of Evidence: A) Nitrates and beta-blockers (in conjunction with diuretics) for the treatment of angina in patients with HF. (Level of Evidence: B)

Coronary revascularization in patients who have both HF and angina. (Level of Evidence: A)

Anticoagulants in patients with HF who have paroxysmal or chronic atrial fibrillation or a previous thromboembolic event. (Level of Evidence: A)

Control of the ventricular response in patients with HF and atrial fibrillation with a beta-blocker (or amiodarone, if the beta-blocker is contraindicated or not tolerated). (Level of Evidence: A)

Beta-adrenergic blockade (unless contraindicated) in patients with HF to reduce the risk of sudden death. Patients should have no or minimal fluid retention and should not have recently required treatment with an intravenous positive inotropic agent. (Level of Evidence: A)

Implantable cardioverter-defibrillator, alone or in combination with amiodarone, in patients with HF who have a history of sudden death, ventricular fibrillation, or hemodynamically destabilizing ventricular tachycardia. (Level of Evidence: A)

Class IIa recommendations

Antiplatelet agents for prevention of myocardial infarction and death in patients with HF who have underlying coronary artery disease. (Level of Evidence: B)

Digitalis to control the ventricular response in patients with HF and atrial fibrillation. (Level of Evidence: A)

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