Category:Heart failure medications: Difference between revisions

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A '''heart failure ~~medication~~''' is ~~a medicine~~ used in the management of [[wikipedia:Heart failure|heart failure]], the clinical syndrome that results when the heart cannot pump enough blood to meet the metabolic demands of the body or can only do so at the cost of elevated filling pressures. The category covers, by clinical use, the medicines that have been shown to reduce mortality and hospitalisation in heart failure with reduced ejection fraction (HFrEF), the medicines that improve symptoms and reduce hospitalisation in heart failure with preserved ejection fraction (HFpEF), the diuretics and venodilators used to manage congestion across the spectrum, and the inotropes and mechanical-support adjuncts of acute decompensation.

A '''heart failure medicine''' is one used in the management of [[wikipedia:Heart failure|heart failure]], the clinical syndrome that results when the heart cannot pump enough blood to meet the metabolic demands of the body or can only do so at the cost of elevated filling pressures. The category covers, by clinical use, the medicines that have been shown to reduce mortality and hospitalisation in heart failure with reduced ejection fraction (HFrEF), the medicines that improve symptoms and reduce hospitalisation in heart failure with preserved ejection fraction (HFpEF), the diuretics and venodilators used to manage congestion across the spectrum, and the inotropes and mechanical-support adjuncts of acute decompensation.

The first effective heart-failure medicine was a botanical preparation that has remained in use, with refinements, for more than two centuries. In 1785 the English physician [[wikipedia:William Withering|William Withering]] of [[wikipedia:Birmingham|Birmingham]] published ''An Account of the Foxglove, and Some of its Medical Uses'', the result of a decade of careful observation in patients with dropsy (the clinical syndrome of fluid retention now recognised as congestive heart failure).<ref name="withering1785">Withering W. ''An Account of the Foxglove and Some of Its Medical Uses, with Practical Remarks on Dropsy, and Other Diseases''. Birmingham: Robinson; 1785.</ref> Withering had been shown the foxglove (''[[wikipedia:Digitalis purpurea|Digitalis purpurea]]'') tea by a Shropshire countrywoman who had had clinical success with it, identified the leaf as the active part, established a dose-response, and characterised the cardiac glycoside toxicity (visual disturbance, nausea, bradycardia, arrhythmia) that has remained essentially as he described it. [[wikipedia:Digoxin|Digoxin]], isolated from ''Digitalis lanata'' by Sydney Smith in 1930, retains some place in heart-failure management for symptomatic rate control in atrial fibrillation but, after the Digitalis Investigation Group trial of 1997 showed no mortality benefit of routine digoxin in HFrEF, has retreated from first-line maintenance use.<ref name="dig1997">Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. ''New England Journal of Medicine''. 1997 Feb 20;336(8):525-533. PMID 9036306.</ref>

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