Chronic heart failure(HF)is a clinical syndrome with high morbidity and mor-tality worldwide.Cardiac rehabilitation(CR)is a medically supervised program designed to maintain or improve cardiovascular health of people ...Chronic heart failure(HF)is a clinical syndrome with high morbidity and mor-tality worldwide.Cardiac rehabilitation(CR)is a medically supervised program designed to maintain or improve cardiovascular health of people living with HF,recommended by both American and European guidelines.A CR program con-sists of a multispecialty group including physicians,nurses,physiotherapists,trainers,nutritionists,and psychologists with the common purpose of improving functional capacity and quality of life of chronic HF patients.Physical activity,lifestyle,and psychological support are core components of a successful CR program.CR has been shown to be beneficial in all ejection fraction categories in HF and most patients,who are stable under medication,are capable of participating.An individualized exercise prescription should be developed on the basis of a baseline evaluation in all patients.The main modalities of exercise training are aerobic exercise and muscle strength training of different intensity and frequency.It is important to set the appropriate clinical outcomes from the beginning,in order to assess the effectiveness of a CR program.There are still significant limitations that prevent patients from participating in these programs and need to be solved.A significant limitation is the generally low quality of research in CR and the presence of negative trials,such as the rehabilitation after myocardial infarction trial,where comprehensive rehabilitation following myocardial infraction had no important effect on mortality,morbidity,risk factors,or health-related quality of life or activity.In the present editorial,we present all the updated knowledge and recommendations in CR programs.展开更多
Objectives To assess the safety of a cardiac rehabilitation program for older women with Congestive Heart Failure （CHF） and determine if certain factors influence adherence. Methods Women over the age of 65 with CHF...Objectives To assess the safety of a cardiac rehabilitation program for older women with Congestive Heart Failure （CHF） and determine if certain factors influence adherence. Methods Women over the age of 65 with CHF attended an exercise program supervised by a physiotherapist. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire （MLHFQ） and severity of disease by the New York Heart Association （NYHA） Class. Subjects were classified into those who attended 90% or more of the sessions and those who attended less than 90% of the sessions. Results Fifty-one subjects were studied. Eight subjects did not attend any sessions. Of the 43 attendees, the average percentage of sessions attended was 87%. There were no significant differences between the two groups in age, MLHFQ or NYHA Class. There was only one adverse event out of 280 participant attendances. Conclusions The program had a high level of adherence in this population. Age, MLHFQ or NYHA Class did not impact on session attendance. Our data suggests this program is safe for this population. Further research is needed to determine other predictors of attendance and the examination of safety issues and long-term adherence to exercise in this population.展开更多
Congestive heart failure （CHF） has emerged as a major worldwide epidemic and its main causes seem to be the aging of the population and the survival of patients with post-myocardial infarction. Cardiomyocyte dropout...Congestive heart failure （CHF） has emerged as a major worldwide epidemic and its main causes seem to be the aging of the population and the survival of patients with post-myocardial infarction. Cardiomyocyte dropout （necrosis and apoptosis） plays a critical role in the progress of CHF; thus treatment of CHF by exogenous cell implantation will be a promising medical approach. In the acute phase of cardiac damage cardiac stem cells （CSCs） within the heart divide symmetrically and/or asymmetrically in response to the change of heart homeostasis, and at the same time homing of bone marrow stem cells （BMCs） to injured area is thought to occur, which not only reconstitutes CSC population to normal levels but also repairs the heart by differentiation into cardiac tissue. So far, basic studies by using potential sources such as BMCs and CSCs to treat animat CHF have shown improved ventricular remodelling and heart function. Recently, however, a few of randomized, double-blind, placebo-controlled clinical trials demonstrated mixed results in heart failure with BMC therapy during acute myocardial infarction.展开更多
Objective:To investigate the effects of rehabilitation exercise therapy on 6-minute walking distance (6 minute walk distance, 6MWD), brain natriuretic titanium (Brain natriuretic peptide, BNP) and (Minnesota heart fai...Objective:To investigate the effects of rehabilitation exercise therapy on 6-minute walking distance (6 minute walk distance, 6MWD), brain natriuretic titanium (Brain natriuretic peptide, BNP) and (Minnesota heart failure quality of life scale, MLHFQ score in elderly patients with chronic heart failure (CHF).Methods: Choose xi'an medical college affiliated hospital heart treated with 96 cases of elderly patients with chronic heart failure (from January 2016 to January 2018), according to random number table method, divide the patients as control group and observation group 48 cases/group, control group to implement regular heart failure treatment, the observation group in the control group, the implementation of rehabilitation exercise therapy on the basis of comparing the clinical curative effect of two groups of indicators, heart colour to exceed, 6 MWDS, BNP levels, plate movement, MLHFQ score. Results: (1) compared with the control group, the total effective rate of the observation group was higher than that of the control group (P<0.05). (2). After treatment, the left ventricular end-diastolic diameter (Left ventricular end diastolic diameter, LVEDD) and the left ventricular end-systolic diameter (Left ventricular end systolic diameter, LVESD), BNP) in the observation group were higher than those in the control group. All the MLHFQ scores were lower than those in the control group (P<0.05). The left ventricular ejection fraction (Left ventricular ejection fraction, LVEF), stroke output (Stroke volume, SV) and treadmill metabolic equivalent (Metabolic equivalent, METs) were higher than those in the control group (P<0.05). The treadmill exercise time was longer than that in the control group (P<0.05), and its 6MWD was higher than that in the control group (P<0.05).Conclusion: Rehabilitation exercise therapy in elderly patients with chronic heart failure can effectively improve the cardiac function, enhance their exercise endurance and energy metabolism level, and improve the clinical efficacy and quality of life.展开更多
Objective: This study investigated the effects of cardiac rehabilitation exercise protocols on physical function (PF) in patients with chronic heart failure (CHF). Study Design and Setting: This randomized controlled ...Objective: This study investigated the effects of cardiac rehabilitation exercise protocols on physical function (PF) in patients with chronic heart failure (CHF). Study Design and Setting: This randomized controlled trial recruited 70 patients who are in stage II CHF with ejection fraction (≤40%) from a Nigerian university teaching hospital. They were randomly assigned into Exercise Group (EG: n = 35) or Control Group (CG: n = 35). Physical function, activity of daily living (ADL), distance walked in six minutes and grip strength were assessed using a validated ADL questionnaire, six minute walk test and a hand dynamometer respectively. In addition to medication, EG underwent aerobic and upper extremity resistance exercises thrice weekly for eight weeks while CG used medications only. Data were analyzed using descriptive and inferential statistics. Alpha level was at p p > 0.05). Significant improvements were noticed at fourth week among participants’ ADL (30.0% ± 6.0%), 6MWD (321.7 ± 26.3 m) and VO<sub>2</sub> max (8.9 ± 0.4 mL/kg/min) variables within the exercise EG but no significant changes were observed in the CG (p > 0.05). Participants in EG demonstrated more significant improvements in ADL (15.0% ± 5.0%), 6MWD (406.0 ± 29.7 m) and VO<sub>2</sub> max (10.3 ± 0.5 mL/kg/min) (p p > 0.05). Conclusions: Cardiac rehabilitation exercise protocols involving self-paced walking, sit-to-stand and upper extremity dynamic strength training improved activity of daily living, walking and functional capacity in patients with stable chronic heart failure.展开更多
The most common symptom of patients with heart failure is reduced exercise tolerance,as indicated by decreased peak oxygen uptake(VO2peak),which is associated with both reduced quality of life and survival.Cardiac reh...The most common symptom of patients with heart failure is reduced exercise tolerance,as indicated by decreased peak oxygen uptake(VO2peak),which is associated with both reduced quality of life and survival.Cardiac rehabilitation is a safe and effective treatment for clinically stable patients with heart failure,and is associated with improvements in cardiopulmonary function,muscle strength,physical functional performance,and quality of life.Further,cardiac rehabilitation is associated with a reduction in heart failure hospitalization and mortality.Despite evidence of these benefits,cardiac rehabilitation referral and compliance among patients with heart failure remains low.In this review,we discuss exercise and training program selection for patients with heart failure,including optimal exercise training intensity,and a summary of recent literature on the use of cardiac rehabilitation for patients with heart failure.展开更多
Congestive heart failure(CHF),the manifestationat the late stage of cardiovascular diseases,is a commonand critical illness.Traditional Chinese medicine showsa good therapeutic effectiveness in treatment of CHF,especi...Congestive heart failure(CHF),the manifestationat the late stage of cardiovascular diseases,is a commonand critical illness.Traditional Chinese medicine showsa good therapeutic effectiveness in treatment of CHF,especially for latent heart failure,refractory heart failureand digitalis poisoning.The thinking on treatment ofCHF by traditional Chinese medicine on the basis ofclinical practice is described below.展开更多
Heart failure represents the end point of a variety of cardiovascular diseases.It is a growing health burden and a leading cause of death worldwide.To date,limited treatment options exist for the treatment of heart fa...Heart failure represents the end point of a variety of cardiovascular diseases.It is a growing health burden and a leading cause of death worldwide.To date,limited treatment options exist for the treatment of heart failure,but exercise has been well-established as one of the few safe and effective interventions,leading to improved outcomes in patients.However,a lack of patient adherence remains a significant barrier in the implementation of exercise-based therapy for the treatment of heart failure.The insulin-like growth factor 1(IGF1)phosphoinositide 3-kinase(PI3K)pathway has been recognized as perhaps the most critical pathway for mediating exercisedinduced heart growth and protection.Here,we discuss how modulating activity of the IGF1PI3K pathway may be a valuable approach for the development of therapies that mimic the protective effects of exercise on the heart.We outline some of the promising approaches being investigated that utilize PI3K-based therapy for the treatment of heart failure.We discuss the implications for cardiac pathology and cardiotoxicity that arise in a setting of reduced PI3K activity.Finally,we discuss the use of animal models of cardiac health and disease,and genetic mice with increased or decreased cardiac PI3K activity for the discovery of novel drug targets and biomarkers of cardiovascular disease.展开更多
BACKGROUND Chronic heart failure(CHF)is a complex syndrome characterized by a progressive reduction of the left ventricular(LV)contractility,low exercise tolerance,and increased mortality and morbidity.Diastolic dysfu...BACKGROUND Chronic heart failure(CHF)is a complex syndrome characterized by a progressive reduction of the left ventricular(LV)contractility,low exercise tolerance,and increased mortality and morbidity.Diastolic dysfunction(DD)of the LV,is a keystone in the pathophysiology of CHF and plays a major role in the progression of most cardiac diseases.Also,it is well estimated that exercise training induces several beneficial effects on patients with CHF.AIM To evaluate the impact of a cardiac rehabilitation program on the DD and LV ejection fraction(EF)in patients with CHF.METHODS Thirty-two stable patients with CHF(age:56±10 years,EF:32%±8%,88%men)participated in an exercise rehabilitation program.They were randomly assigned to aerobic exercise(AER)or combined aerobic and strength training(COM),based on age and peak oxygen uptake,as stratified randomization criteria.Before and after the program,they underwent a symptom-limited maximal cardiopulmonary exercise testing(CPET)and serial echocardiography evaluation to evaluate peak oxygen uptake(VO2peak),peak workload(Wpeak),DD grade,right ventricular systolic pressure(RVSP),and EF.RESULTS The whole cohort improved VO2peak,and Wpeak,as well as DD grade(P<0.05).Overall,9 patients(28.1%)improved DD grade,while 23(71.9%)remained at the same DD grade;this was a significant difference,considering DD grade at baseline(P<0.05).In addition,the whole cohort improved RVSP and EF(P<0.05).Not any between-group differences were observed in the variables assessed(P>0.05).CONCLUSION Exercise rehabilitation improves indices of diastolic and systolic dysfunction.Exercise protocol was not observed to affect outcomes.These results need to be further investigated in larger samples.展开更多
Congestive heart failure is a disease in which initially compensatory changes in cardiac , vascular, and renal functions become detrimental over time. The changes are mediated by a large number of neurohormones and cy...Congestive heart failure is a disease in which initially compensatory changes in cardiac , vascular, and renal functions become detrimental over time. The changes are mediated by a large number of neurohormones and cytokines. Counter-regulatory hormones also play a role, but are generally insufficient to offset the adverse effects of the neurohormones or progression of the disease. Symptoms of heart failure occurs in the 'presence of systolic dysfunction, usually documented by a decrease in ejection fraction, or can present with impaired diastolic function occasionally labeled as heart failure with preserved systolic function of the left ventricle. Heart failure and its treatment represent a medical problem of significant importance because of the high mortality associated with it despite the current therapy , which has substantial evidence of reduction in mortality and morbidity. Prevention or slowing of the progressive deterioration in function of the heart and other organs involved through utilizing new agents that affect more or different neurohormonal pathways may be beneficial and forms the focus of heart failure research and drug development. However , the multiplicity of hormonal effects mandate the use of complex therapy in the management of congestive heart failure(CHF). The new agents in addition to the conventional therapy used in the management of heart failure are; Human B-type nalriuretic peptide (in the treatment of decompensated CHF) , endothelin receptor antagonists, calcium sensitizers, neutral endopeptidase (NEP) and vasopeptidase inhibitors, vasopressin antagonists and cytokine inhibitors.展开更多
文摘Chronic heart failure(HF)is a clinical syndrome with high morbidity and mor-tality worldwide.Cardiac rehabilitation(CR)is a medically supervised program designed to maintain or improve cardiovascular health of people living with HF,recommended by both American and European guidelines.A CR program con-sists of a multispecialty group including physicians,nurses,physiotherapists,trainers,nutritionists,and psychologists with the common purpose of improving functional capacity and quality of life of chronic HF patients.Physical activity,lifestyle,and psychological support are core components of a successful CR program.CR has been shown to be beneficial in all ejection fraction categories in HF and most patients,who are stable under medication,are capable of participating.An individualized exercise prescription should be developed on the basis of a baseline evaluation in all patients.The main modalities of exercise training are aerobic exercise and muscle strength training of different intensity and frequency.It is important to set the appropriate clinical outcomes from the beginning,in order to assess the effectiveness of a CR program.There are still significant limitations that prevent patients from participating in these programs and need to be solved.A significant limitation is the generally low quality of research in CR and the presence of negative trials,such as the rehabilitation after myocardial infarction trial,where comprehensive rehabilitation following myocardial infraction had no important effect on mortality,morbidity,risk factors,or health-related quality of life or activity.In the present editorial,we present all the updated knowledge and recommendations in CR programs.
文摘Objectives To assess the safety of a cardiac rehabilitation program for older women with Congestive Heart Failure （CHF） and determine if certain factors influence adherence. Methods Women over the age of 65 with CHF attended an exercise program supervised by a physiotherapist. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire （MLHFQ） and severity of disease by the New York Heart Association （NYHA） Class. Subjects were classified into those who attended 90% or more of the sessions and those who attended less than 90% of the sessions. Results Fifty-one subjects were studied. Eight subjects did not attend any sessions. Of the 43 attendees, the average percentage of sessions attended was 87%. There were no significant differences between the two groups in age, MLHFQ or NYHA Class. There was only one adverse event out of 280 participant attendances. Conclusions The program had a high level of adherence in this population. Age, MLHFQ or NYHA Class did not impact on session attendance. Our data suggests this program is safe for this population. Further research is needed to determine other predictors of attendance and the examination of safety issues and long-term adherence to exercise in this population.
基金Project (No. 20060400200) supported by the Postdoctoral ScienceFoundation, China
文摘Congestive heart failure （CHF） has emerged as a major worldwide epidemic and its main causes seem to be the aging of the population and the survival of patients with post-myocardial infarction. Cardiomyocyte dropout （necrosis and apoptosis） plays a critical role in the progress of CHF; thus treatment of CHF by exogenous cell implantation will be a promising medical approach. In the acute phase of cardiac damage cardiac stem cells （CSCs） within the heart divide symmetrically and/or asymmetrically in response to the change of heart homeostasis, and at the same time homing of bone marrow stem cells （BMCs） to injured area is thought to occur, which not only reconstitutes CSC population to normal levels but also repairs the heart by differentiation into cardiac tissue. So far, basic studies by using potential sources such as BMCs and CSCs to treat animat CHF have shown improved ventricular remodelling and heart function. Recently, however, a few of randomized, double-blind, placebo-controlled clinical trials demonstrated mixed results in heart failure with BMC therapy during acute myocardial infarction.
基金Natural Science Foundation Project of Shaanxi Education Department(No.12JK0707)The routine subject of Shaanxi Sports Bureau.Project (No.17016,17016).
文摘Objective:To investigate the effects of rehabilitation exercise therapy on 6-minute walking distance (6 minute walk distance, 6MWD), brain natriuretic titanium (Brain natriuretic peptide, BNP) and (Minnesota heart failure quality of life scale, MLHFQ score in elderly patients with chronic heart failure (CHF).Methods: Choose xi'an medical college affiliated hospital heart treated with 96 cases of elderly patients with chronic heart failure (from January 2016 to January 2018), according to random number table method, divide the patients as control group and observation group 48 cases/group, control group to implement regular heart failure treatment, the observation group in the control group, the implementation of rehabilitation exercise therapy on the basis of comparing the clinical curative effect of two groups of indicators, heart colour to exceed, 6 MWDS, BNP levels, plate movement, MLHFQ score. Results: (1) compared with the control group, the total effective rate of the observation group was higher than that of the control group (P<0.05). (2). After treatment, the left ventricular end-diastolic diameter (Left ventricular end diastolic diameter, LVEDD) and the left ventricular end-systolic diameter (Left ventricular end systolic diameter, LVESD), BNP) in the observation group were higher than those in the control group. All the MLHFQ scores were lower than those in the control group (P<0.05). The left ventricular ejection fraction (Left ventricular ejection fraction, LVEF), stroke output (Stroke volume, SV) and treadmill metabolic equivalent (Metabolic equivalent, METs) were higher than those in the control group (P<0.05). The treadmill exercise time was longer than that in the control group (P<0.05), and its 6MWD was higher than that in the control group (P<0.05).Conclusion: Rehabilitation exercise therapy in elderly patients with chronic heart failure can effectively improve the cardiac function, enhance their exercise endurance and energy metabolism level, and improve the clinical efficacy and quality of life.
文摘Objective: This study investigated the effects of cardiac rehabilitation exercise protocols on physical function (PF) in patients with chronic heart failure (CHF). Study Design and Setting: This randomized controlled trial recruited 70 patients who are in stage II CHF with ejection fraction (≤40%) from a Nigerian university teaching hospital. They were randomly assigned into Exercise Group (EG: n = 35) or Control Group (CG: n = 35). Physical function, activity of daily living (ADL), distance walked in six minutes and grip strength were assessed using a validated ADL questionnaire, six minute walk test and a hand dynamometer respectively. In addition to medication, EG underwent aerobic and upper extremity resistance exercises thrice weekly for eight weeks while CG used medications only. Data were analyzed using descriptive and inferential statistics. Alpha level was at p p > 0.05). Significant improvements were noticed at fourth week among participants’ ADL (30.0% ± 6.0%), 6MWD (321.7 ± 26.3 m) and VO<sub>2</sub> max (8.9 ± 0.4 mL/kg/min) variables within the exercise EG but no significant changes were observed in the CG (p > 0.05). Participants in EG demonstrated more significant improvements in ADL (15.0% ± 5.0%), 6MWD (406.0 ± 29.7 m) and VO<sub>2</sub> max (10.3 ± 0.5 mL/kg/min) (p p > 0.05). Conclusions: Cardiac rehabilitation exercise protocols involving self-paced walking, sit-to-stand and upper extremity dynamic strength training improved activity of daily living, walking and functional capacity in patients with stable chronic heart failure.
基金This work was supported by the National Natural Science Foundation of China(NO.81904153,NO.81603568)the Tianjin science and technology project:clinical medicine research center of Internal medicine of TCM in Tianjin(15ZXLCSY00020)+2 种基金the“Innovation team development Plan”of Ministry of Education-Research on the prevention and treatment of cardiovascular diseases in traditional Chinese medicine(IRT 16R54)the State Administration of traditional Chinese Medicine(SATCM),the National Clinical Research Base of Chinese Medicine(No.JDZX2015005)and the Najor Science and Technology Project of Tianjin(No.16zxmjsy00050).
文摘The most common symptom of patients with heart failure is reduced exercise tolerance,as indicated by decreased peak oxygen uptake(VO2peak),which is associated with both reduced quality of life and survival.Cardiac rehabilitation is a safe and effective treatment for clinically stable patients with heart failure,and is associated with improvements in cardiopulmonary function,muscle strength,physical functional performance,and quality of life.Further,cardiac rehabilitation is associated with a reduction in heart failure hospitalization and mortality.Despite evidence of these benefits,cardiac rehabilitation referral and compliance among patients with heart failure remains low.In this review,we discuss exercise and training program selection for patients with heart failure,including optimal exercise training intensity,and a summary of recent literature on the use of cardiac rehabilitation for patients with heart failure.
文摘Congestive heart failure(CHF),the manifestationat the late stage of cardiovascular diseases,is a commonand critical illness.Traditional Chinese medicine showsa good therapeutic effectiveness in treatment of CHF,especially for latent heart failure,refractory heart failureand digitalis poisoning.The thinking on treatment ofCHF by traditional Chinese medicine on the basis ofclinical practice is described below.
基金All authors are supported by the Victorian Government’s Operational Infrastructure Support ProgramSBS is supported by a joint Baker Heart and Diabetes Institute-La Trobe University doctoral scholarshipRM is supported by a National Health and Medical Research Council Senior Research Fellowship(Grant No.1078985).
文摘Heart failure represents the end point of a variety of cardiovascular diseases.It is a growing health burden and a leading cause of death worldwide.To date,limited treatment options exist for the treatment of heart failure,but exercise has been well-established as one of the few safe and effective interventions,leading to improved outcomes in patients.However,a lack of patient adherence remains a significant barrier in the implementation of exercise-based therapy for the treatment of heart failure.The insulin-like growth factor 1(IGF1)phosphoinositide 3-kinase(PI3K)pathway has been recognized as perhaps the most critical pathway for mediating exercisedinduced heart growth and protection.Here,we discuss how modulating activity of the IGF1PI3K pathway may be a valuable approach for the development of therapies that mimic the protective effects of exercise on the heart.We outline some of the promising approaches being investigated that utilize PI3K-based therapy for the treatment of heart failure.We discuss the implications for cardiac pathology and cardiotoxicity that arise in a setting of reduced PI3K activity.Finally,we discuss the use of animal models of cardiac health and disease,and genetic mice with increased or decreased cardiac PI3K activity for the discovery of novel drug targets and biomarkers of cardiovascular disease.
文摘BACKGROUND Chronic heart failure(CHF)is a complex syndrome characterized by a progressive reduction of the left ventricular(LV)contractility,low exercise tolerance,and increased mortality and morbidity.Diastolic dysfunction(DD)of the LV,is a keystone in the pathophysiology of CHF and plays a major role in the progression of most cardiac diseases.Also,it is well estimated that exercise training induces several beneficial effects on patients with CHF.AIM To evaluate the impact of a cardiac rehabilitation program on the DD and LV ejection fraction(EF)in patients with CHF.METHODS Thirty-two stable patients with CHF(age:56±10 years,EF:32%±8%,88%men)participated in an exercise rehabilitation program.They were randomly assigned to aerobic exercise(AER)or combined aerobic and strength training(COM),based on age and peak oxygen uptake,as stratified randomization criteria.Before and after the program,they underwent a symptom-limited maximal cardiopulmonary exercise testing(CPET)and serial echocardiography evaluation to evaluate peak oxygen uptake(VO2peak),peak workload(Wpeak),DD grade,right ventricular systolic pressure(RVSP),and EF.RESULTS The whole cohort improved VO2peak,and Wpeak,as well as DD grade(P<0.05).Overall,9 patients(28.1%)improved DD grade,while 23(71.9%)remained at the same DD grade;this was a significant difference,considering DD grade at baseline(P<0.05).In addition,the whole cohort improved RVSP and EF(P<0.05).Not any between-group differences were observed in the variables assessed(P>0.05).CONCLUSION Exercise rehabilitation improves indices of diastolic and systolic dysfunction.Exercise protocol was not observed to affect outcomes.These results need to be further investigated in larger samples.
文摘Congestive heart failure is a disease in which initially compensatory changes in cardiac , vascular, and renal functions become detrimental over time. The changes are mediated by a large number of neurohormones and cytokines. Counter-regulatory hormones also play a role, but are generally insufficient to offset the adverse effects of the neurohormones or progression of the disease. Symptoms of heart failure occurs in the 'presence of systolic dysfunction, usually documented by a decrease in ejection fraction, or can present with impaired diastolic function occasionally labeled as heart failure with preserved systolic function of the left ventricle. Heart failure and its treatment represent a medical problem of significant importance because of the high mortality associated with it despite the current therapy , which has substantial evidence of reduction in mortality and morbidity. Prevention or slowing of the progressive deterioration in function of the heart and other organs involved through utilizing new agents that affect more or different neurohormonal pathways may be beneficial and forms the focus of heart failure research and drug development. However , the multiplicity of hormonal effects mandate the use of complex therapy in the management of congestive heart failure(CHF). The new agents in addition to the conventional therapy used in the management of heart failure are; Human B-type nalriuretic peptide (in the treatment of decompensated CHF) , endothelin receptor antagonists, calcium sensitizers, neutral endopeptidase (NEP) and vasopeptidase inhibitors, vasopressin antagonists and cytokine inhibitors.
