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Congestive Heart Failure
EKG,[object Object]
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
In all cases,[object Object],In selected cases,[object Object]
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
32 trials (3870 ACE inhibitors & 3235 placebo),[object Object],􀁺 The reductions in mortality from CHF were greater for men than for women, for age < 60 years than for age > 60 years, for NYHA class IV, for ejection fraction <0.25, and for CHF caused by ischemic heart disease. ,[object Object],[object Object],􀁺 The groups did not differ for reductions in sudden death or fatal MI,[object Object]
Congestive Heart Failure
Congestive Heart Failure
123 articles 18 trials 2986 patients,[object Object],􀁺 7 (n = 562) of metoprolol, 2 (n = 1509) of carvedilol, 2 (n = 36) of nebivolol, 1 (n= 	641) of bisoprolol, 1 (n = 17) of acebutolol & 1 (n = 12) of labetalol,[object Object],􀁺 Improved LVEF (P < 0.001) (11 trials),[object Object],􀁺 Higher rates of bradycardia, hypotension, and dizziness (P < 0.001) (13 trials),[object Object],􀁺 A decreased rate of worsening of heart failure (P < 0.001) (13 trials),[object Object],􀁺 no difference between β-blockers placebo for maximum exercise duration (9 trials),[object Object]
Congestive Heart Failure
Congestive Heart Failure
􀁺 No difference in deaths 1181 vs 1194,[object Object],􀁺 More patients in the digoxin group were hospitalized for digoxin toxicity than in,[object Object],the placebo group (P < 0.001),[object Object],􀁺 Subgroup analyses suggested a greater benefit among patients at high risk,[object Object],patients,[object Object],Conclusions,[object Object],􀁺 Digoxin did not affect mortality but reduced hospitalizations in patients with heart,[object Object],failure and normal sinus rhythm.,[object Object],􀁺 May need to be cautious in female where overdosing may occur,[object Object]
Congestive Heart Failure
Congestive Heart Failure
􀁺 Main results,[object Object],􀁺 greater improvement in NYHA class (P < 0.001),[object Object],􀁺 did not differ for adverse effects: 82% of patients in the spironolactone group had ≥ 1 event,[object Object],compared with 79% of patients in the placebo group (P = 0.17),[object Object],􀁺 “serious hyperkalemia” 1% vs 2% (ns); no comment on mild-moderate,[object Object],􀁺 men in tx group had higher rate of gynecomastia or breast pain (10% vs 1%, P < 0.001).,[object Object],Conclusion,[object Object],􀁺 Spironolactone reduced all-cause mortality, death, and hospitalization from cardiac causes and,[object Object],death from CHF and improved NYHA functional class in patients with severe CHF.,[object Object]
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Heart Failure & Sudden Cardiac Arrest,[object Object],Framingham Heart study – Heart Failure predicts SCD and overall mortality,[object Object],Reduced Left Ventricular Ejection Fraction & risk for sudden cardiac arrest,[object Object]
Sudden cardiac Death ,[object Object],SCD-HeFT Trial,[object Object],Implantable Defibrillator,[object Object],ICD significantly reduced mortality at 4 year follow up,[object Object]
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure
Congestive Heart Failure

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Congestive Heart Failure

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