Can adult heart failure regimens be applied to children: What works and what does not?

PURPOSE OF REVIEW: Review of the evidence for current ambulatory heart failure treatment regimens in adults and their applicability in pediatric heart failure. RECENT FINDINGS: There is promising recent research in treatment with phosphodiesterase-5 inhibitors in single ventricle patients with heart failure, including possible benefits to reduce symptoms and improve exercise tolerance. SUMMARY: Therapies for adults cannot be assumed to be generally applicable to all pediatric heart failure patients, especially in patients with systemic right ventricles or single ventricle physiology. Contrary to adult heart failure regimens, evidence supports treatment of symptomatic, but not asymptomatic, heart failure with angiotensin-converting enzyme inhibitors and beta-blockers in certain pediatric patients. Implantable cardioverter defibrillators continue to be used sparingly in children compared with adults due to low risk of sudden cardiac death. Finally, cardiac resynchronization therapy may be beneficial in children with symptomatic heart failure and moderate to severe dysfunction, although applying adult criteria to children remains a challenge.