Editorials

The ABCs of Treating Congestive Heart Failure



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Am Fam Physician. 2001 Sep 15;64(6):934-938.

  Related Article

In a two-part article published in this issue and the previous issue of American Family Physician, Chavey and associates1,2 summarize current guidelines for the treatment of congestive heart failure caused by systolic dysfunction. As with guidelines in general, putting this one into practice is, by way of paraphrase, easier “read” than done. Studies repeatedly show the poor track record physicians have in implementing clinical guidelines—even ones with which they agree.3,4 This is probably more true in cardiovascular medicine than in most other fields. Physicians, cardiologists and primary care physicians alike, often fail to prescribe aspirin and beta blockers after myocardial infarction, or fail to use angiotensin-converting enzyme inhibitors in patients with congestive heart failure, despite the proven benefits of these medications.

TABLE 1

ABC Mnemonic for the Treatment of Coronary Artery Disease

A Aspirin* and antianginal agents*

B Beta blockers* and blood pressure control*

C Cholesterol lowering* and cigarette cessation*

D Diet (low fat)† and diabetes control†

E Education† and exercise†


*—Shown to improve survival.

†—Shown to improve symptoms and function.

Adapted with permission from Gibbon RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angine). J Am Coll Cardiol 1999;33:2092–197; retrieved July 2001, from: http://www.americanheart.org/Scientific/statements/1999/stable_angina.

TABLE 1   ABC Mnemonic for the Treatment of Coronary Artery Disease

View Table

TABLE 1

ABC Mnemonic for the Treatment of Coronary Artery Disease

A Aspirin* and antianginal agents*

B Beta blockers* and blood pressure control*

C Cholesterol lowering* and cigarette cessation*

D Diet (low fat)† and diabetes control†

E Education† and exercise†


*—Shown to improve survival.

†—Shown to improve symptoms and function.

Adapted with permission from Gibbon RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angine). J Am Coll Cardiol 1999;33:2092–197; retrieved July 2001, from: http://www.americanheart.org/Scientific/statements/1999/stable_angina.

The American College of Cardiology and the American Heart Association have developed a simple mnemonic to help physicians remember the ABCs of cardiovascular therapy (Table 1).5  Because of the overlap in treatment between coronary heart disease and congestive heart failure, these ABCs could readily be adapted to the latter condition (Table 2). Not all of the listed interventions will apply to every patient, and not all have been shown to reduce morbidity and mortality. However, the mnemonic is useful for reminding physicians about key considerations in treating congestive heart failure. So, when treating patients with congestive heart failure, remember your ABCs!

TABLE 2

ABC Mnemonic for the Treatment of Congestive Heart Failure

A Angiotensin-converting enzyme inhibitors,* aldosterone antagonist (spironolactone [Aldactone] for moderate to severe congestive heart failure)*

B Beta blockers (e.g., carvedilol [Coreg])*

C Cigarette cessation†

D Diet (low salt),† diuretics,† digoxin (Lanoxin)†

E Education,† exercise†


*—Shown to improve survival.

†—Shown to improve symptoms and function.

TABLE 2   ABC Mnemonic for the Treatment of Congestive Heart Failure

View Table

TABLE 2

ABC Mnemonic for the Treatment of Congestive Heart Failure

A Angiotensin-converting enzyme inhibitors,* aldosterone antagonist (spironolactone [Aldactone] for moderate to severe congestive heart failure)*

B Beta blockers (e.g., carvedilol [Coreg])*

C Cigarette cessation†

D Diet (low salt),† diuretics,† digoxin (Lanoxin)†

E Education,† exercise†


*—Shown to improve survival.

†—Shown to improve symptoms and function.

Jay Siwek is professor and chair of the Department of Family Medicine at Georgetown University School of Medicine. He is also the editor of American Family Physician.

Address correspondence to Jay Siwek, M.D., Department of Family Medicine, 212 Kober-Cogan Hall, Georgetown University Medical Center, 3800 Reservoir Rd. NW, Washington, D.C. 20007 (e-mail: siwekj@georgetown.edu).

REFERENCES

1. Chavey WE II, Blaum CS, Bleske BE, Harrison RV, Kesterson S, Nicklas JM. Guideline for the management of heart failure caused by systolic dysfunction: Part II. Treatment. Am Fam Physician. 2001;64:1045–54.

2. Chavey WE II, Blaum CS, Bleske BE, Harrison RV, Kesterson S, Nicklas JM. Guideline for the management of heart failure caused by systolic dysfunction: Part I. Guideline development, etiology and diagnosis. Am Fam Physician. 2001;64:769–74.

3. Cohen JD. ABCs of secondary prevention of CHD: easier said than done. Lancet. 2001;357:972–3.

4. Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. EUROASPIRE I and II Group. European Action on Secondary Prevention by Intervention to Reduce Events. Lancet. 2001;357:995–1001.

5. Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). J Am Coll Cardiol 1999;33:2092–197. Retrieved July 2001, from: http://www.americanheart.org/Scientific/statements/1999/stable_angina.


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