The Prevention of Heart Failure — A New Agenda

Chronic congestive heart failure is often a lethal disease. Even though clinical trials have documented improved survival when enalapril^{1 2 3} or hydralazine plus isosorbide dinitrate^{3 , 4} was added to digoxin and diuretic therapy, more than 40 percent of the patients in such trials died in the first four years after enrollment. The emphasis has therefore begun to shift toward preventive strategies that are based on physiologic data supporting the idea that cardiac dysfunction and symptoms progress independently from the underlying myocardial disease.⁵ The results of three different approaches to the prevention of heart failure are described in this issue of the Journal…