Diagnostic et traitement de l'insuffisance cardiaque

The incidence of heart failure is consistently progressing among our population; it now represents a major problem of public health and is extremely costly for our health system. Over recent years, several well controlled studies have been devoted to heart failure. They allow to propose guidelines which fulfill all the requirements of Evidence-Based Medicine. These recommendations, however, are not always easy to apply in the individual patient. Guidelines for the sometimes difficult diagnosis of heart failure will be reviewed. On the basis of the results of large controlled clinical trials, we shall envisage the comprehensive treatment of a heart failure patient taking into account the functional class as well as some individual characteristics (age, presence of hypertension, atrial fibrillation, renal insufficiency). The different pharmacologic agents which have demonstrated efficacy will be reviewed and the strategies to avoid the potential pitfalls of their simultaneous use will be indicated. The key role of the general practitioner in the surveillance and titration of heart failure therapy will be emphasized.