Pharmacological Therapy in COMPANION Study: Compliance and Dosage

Abstract

A widely used definition of heart failure is ‘failure of the heart to maintain systemic perfusion commensurate with the requirements of metabolizing tissues.’ This definition and view of myocardial failure dominated the development of medical treatment strategies for the clinical syndrome of heart failure between the mid-1960s and the mid-1980s (the cardiorenal model), and the pharmacological approaches in this period were designed to bring about an acute increase in the performance of weakened heart muscle. Myocardial systolic dysfunction is best demonstrated as a downward and rightward shift in the Frank-Starling relation or a plot of preload or resting length versus myocardial performance. It was largely because positive inotropic agents can acutely shift the cardiac output/preload relation upward and to the left that the initial attempts to improve the natural history of chronic heart failure (CHF) took the form of these types of pharmacological therapy.