Emphasis on the management of heart failure has shifted from attempts to alter hemodynamics and symptoms to attempts to interfere with the natural history of the disease. This shift in emphasis has been stimulated by the recognition that heart failure progresses despite therapy and that shortened life expectancy makes the disease as lethal as most cancers. Most recent trials have therefore focused on mortality and have evaluated therapies designed to impact on progression of the syndrome. In this article the results of several recent trials are discussed, as well as the future of effective therapy.
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