is There Any Evidence-based Medicine for the Very Old?
is There Any Evidence-based Medicine for the Very Old?
is There Any Evidence-based Medicine for the Very Old?
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Pharmacological <strong>the</strong>rapy of heart failure due to Left<br />
Ventricular Systolic Dysfunction<br />
NYHA I reduce / stop diuretic<br />
NYHA II<br />
NYHA III<br />
NYHA IV<br />
For Survival/Morbidity<br />
mandatory <strong>the</strong>rapy<br />
Cont. ACE inhibitor/ARB if ACE<br />
inhibitor intolerant, continue<br />
aldosterone antagon<strong>is</strong>t if post-MI<br />
add beta-blocker if post-MI<br />
ACE inhibitor as first-line<br />
treatment/ARB if ACE inhibitor<br />
intolerant<br />
add beta-blocker<br />
and aldosterone antagon<strong>is</strong>t if post MI<br />
ACE inhibitor plus ARB or ARB<br />
alone if ACE intolerant<br />
beta- blocker<br />
add aldosterone<br />
antagon<strong>is</strong>t<br />
Continue ACE inhibitor/ARB<br />
beta-blocker<br />
Aldosterone antagon<strong>is</strong>t<br />
For Symptoms<br />
+/- diuretic<br />
depending on fluid<br />
retention<br />
+ diuretics + digital<strong>is</strong><br />
If still symptomatic<br />
+diuretics + digital<strong>is</strong><br />
+ consider temporary<br />
inotropic support<br />
Swedberg, Eur Heart J, June 2005; 26: 1115 - 1140.
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