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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