Heart failure syndrome (HF) is one of the major public health concerns, since the number of aged people who are susceptible for HF are increasing and donor supply for cardiac transplantation is limited in Japan. Several clinical trials have established that beta-adrenergic receptor blockers are most useful in prolonging life expectancy in general population of HF in addition to renin-angiotensin system blockade. However, several problems remain to be solved. HF is accompanied by multiple comorbidities, especially in elderly patients. Use of evidence-based medicines is limited in such patients. Epidemiological survey has shown that there are considerable differences in general practices by the countries. In addition, couples of novel pharmacologic therapies such as ivabradine and angiotensin-neprilysin inhibitor remain to be approved in our country. Finally, therapeutic strategy for HF with predominantly diastolic dysfunction is another concern. HF with preserved ejection fraction is the most important issue as a new economic burden of coming era. Renin-angiotensin system blockade appears to be promising in patients with HF due to predominantly diastolic dysfunction, which is a common setting in elderly people.
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