Chronic heart failure

This is based on the St Andrews Day presentation by McMurray.

Heart failure treatment guidelines 2008

Heart failure guidelines in 2008 made the addition of aldosterone antagonists or ARBs routine.

Evidence for addition of ARB comes from VALHEFT and CHARM-Added trials.

2008 heart failure treatment guidelines

Cumulative benefit of polypharmacy in heart failure treatment

Survival improvement in mild-moderate heart failure Survival improvement in severe heart failure

Benefit of cardiac resynchronisation therapy and implantable cardiac defibrillators

Survival benefit from CRT Survival benefit from ICD

Cardiorenal syndrome

Efficacy of diuretics is attenuated by renal autoregulation - distal tubular adenosine release causes afferent arteriolar constriction and proximal tubular sodium resorption.

Agents to inhibit adenosine release/action in kidney cause diuresis with an increase in GFR.

Cardiorenal syndrome Adenosine antagonist induces diuresis with increased GFR