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

See article on page1045.

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.

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

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!

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†

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