19. Treatment of Congestive Heart Failure

The goals of heart failure treatment include both symptomatic improvement and prolongation of life. These goals are not necessarily concordant. Related to this problem is the observation that the acute actions of an intervention may be very different than the chronic effects. When treating heart failure, therefore, one must understand the immediate and long-term desires of a particular patient and the immediate and long-term consequences of one’s therapy. The result is an uncomfortable use of acute treatments known to have adverse consequences when given for a prolonged period and chronic treatments which are counterintuitive. Fortunately, however, congestive heart failure has been well investigated with multiple large studies demonstrating the multiple consequences of many of our standard interventions.