Chronic Heart Failure

Heart failure is the leading cause of hospitalization in the Medicare age group. The prognosis for established heart failure in persons over age 65 is poor, with 5-year survival rates of less than 50% in both men and women.The pharmacotherapy of systolic heart failure is well established, with angiotensin-converting enzyme inhibitors and beta-blockers having the most proven benefit. Treatment of diastolic heart failure is an area of active research, but no therapies have been definitively shown to reduce mortality.Unintentional weight loss in heart failure is likely due to both increased energy utilization and decreased availability of fat, protein (amino acids), and carbohydrates despite “normal” caloric intake.Moderate dietary sodium restriction, such as a 2-g sodium diet, is appropriate for most patients with heart failure, and excess fluid intake should be avoided.Some patients will require supplementation with potassium, calcium, and/or magnesium if adequate amounts cannot be obtained from the diet. However, the importance of most vitamins and other micronutrients in the pathogenesis and treatment of chronic heart failure has not been well characterized. Heart failure is the leading cause of hospitalization in the Medicare age group. The prognosis for established heart failure in persons over age 65 is poor, with 5-year survival rates of less than 50% in both men and women. The pharmacotherapy of systolic heart failure is well established, with angiotensin-converting enzyme inhibitors and beta-blockers having the most proven benefit. Treatment of diastolic heart failure is an area of active research, but no therapies have been definitively shown to reduce mortality. Unintentional weight loss in heart failure is likely due to both increased energy utilization and decreased availability of fat, protein (amino acids), and carbohydrates despite “normal” caloric intake. Moderate dietary sodium restriction, such as a 2-g sodium diet, is appropriate for most patients with heart failure, and excess fluid intake should be avoided. Some patients will require supplementation with potassium, calcium, and/or magnesium if adequate amounts cannot be obtained from the diet. However, the importance of most vitamins and other micronutrients in the pathogenesis and treatment of chronic heart failure has not been well characterized.